The development of nursing interventions that demonstrate the link between nursing actions and patient outcomes is a high priority for nursing research. The development of intervention research frequently focuses on the methods used to test the intervention while less attention is placed on rigor in intervention development and design. The purpose of this paper is to provide thinking points for researchers considering the development of nursing interventions. The thinking points were developed from the limited literature on this topic in synthesis with the authors own experiences of designing nursing interventions. Adoption of a systematic approach to intervention testing is advocated along with a step-wise intervention development process. This process calls for attention to problem definition, conceptual underpinnings, desired outcomes and measures and evidence-based content along with careful consideration of delivery methods, dose and attention to protecting the integrity of the intervention during testing. The approach advocated will help to ensure that nursing intervention research makes a useful contribution to the development of nursing practice.
Hawkins, J W; Roberto, D
This article focuses on the process of development of protocols for family planning nurse practitioners. A rationale for the use of protocols, a definition of the types and examples, and the pros and cons of practice with protocols are presented. A how-to description for the development process follows, including methods and a suggested tool for critique and evaluation. The aim of the article is to assist nurse practitioners in developing protocols for their practice.
Schaffer, Marjorie A.; Anderson, Linda J. W.; Rising, Shannon
School nurses (SNs) use public health nursing knowledge and skills to provide nursing services to school populations. The Public Health Intervention Wheel is a practice framework that can be used to explain and guide public health nursing interventions. SNs who were also members of the National Association of School Nurses completed an electronic…
Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial
Background Functional decline in community-dwelling older persons is associated with the loss of independence, the need for hospital and nursing-home care and premature death. The effectiveness of multifactorial interventions in preventing functional decline remains controversial. The aim of this study is to investigate whether functional decline in community-dwelling older persons can be delayed or prevented by a comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination. Methods/Design In a cluster randomized controlled trial, with the general practice as the unit of randomization, 1281 participants from 25 general practices will be enrolled in each condition to compare the intervention with usual care. The intervention will focus on older persons who are at increased risk for functional decline, identified by an Identification of Seniors at Risk Primary Care (ISAR-PC) score (≥ 2). These older persons will receive a comprehensive geriatric assessment, an individually tailored care and treatment plan, consisting of multifactorial, evidence-based interventions and subsequent nurse-led care coordination. The control group will receive 'care as usual' by the general practitioner (GP). The main outcome after 12 months is the level of physical functioning on the modified Katz-15 index score. The secondary outcomes are health-related quality of life, psychological and social functioning, healthcare utilization and institutionalization. Furthermore, a process evaluation and cost-effectiveness analysis will be performed. Discussion This study will provide new knowledge regarding the effectiveness and feasibility of a comprehensive geriatric assessment, multifactorial interventions and nurse-led elderly care in general practice. Trial registration NTR2653 Grant Unrestricted grant 'The Netherlands Organisation for Health Research and development' no 313020201 PMID:22462516
Cancer diagnoses and treatments can be crisis-causing events that overwhelm the usual coping abilities of patients and their families. Oncology nurses constantly are observing and attending to patients' diverse needs, ranging from biomedical to emotional, social, and psychological. Nurses have the chance to be first responders in times of patient crises, as they are in the position to recognize the crisis, respond effectively, and transform the crisis into a pivotal learning experience. This article discusses a way to think about patient and family crises that empowers nurses to respond in a manner appropriate to the cultural context and respectful of the individual space of the patient.
Schaffer, Marjorie A; Anderson, Linda J W; Rising, Shannon
School nurses (SNs) use public health nursing knowledge and skills to provide nursing services to school populations. The Public Health Intervention Wheel is a practice framework that can be used to explain and guide public health nursing interventions. SNs who were also members of the National Association of School Nurses completed an electronic survey on their use of public health interventions as defined by the wheel. Although 67% of the participants were not familiar with the Public Health Intervention Wheel, respondents reported conducting activities that were consistent with the Wheel interventions. Screening, referral and follow-up, case management, and health teaching were the most frequently performed interventions. Intervention use varied by educational level, age of nurse, years of practice, and student population. The Public Health Intervention Wheel is a relevant and useful framework that provides a language to explain population-based school nursing practice. PMID:26404552
Higa, Rosângela; Mondaca, Aurélia Del Carmen Alvarez; dos Reis, Maria José; Lopes, Maria Helena Baena de Moraes
The Ministry of Health recommends integral and humanized assistance to women victims of sexual violence. This study was aimed at describing the Nursing Protocol in the Attention to Women Victims of Sexual Violence at the Center for Integral Attention to Women's Health of the State University of Campinas (Unicamp), which has recently been revised. To do so, the phases of the nursing process were followed, and after the identification of the main nursing diagnoses of the North American Nursing Diagnosis Association (NANDA) the nursing interventions were determined, based on international and national guidelines care for sexual violence. The current protocol encompasses both immediate and late care, outpatient follow-up and actions regarding legal interruption of pregnancy resulting from rape. The nursing protocol has been providing integral and humanized assistance to women and, for nurses, more autonomy in their area and the possibility of participative and collaborative work with multidisciplinary teams.
Davis, K A
Standardized nursing language is recommended increasingly as a method to describe the work of nursing, adapt to computerized documentation, and establish a place for nursing in national data bases. Nursing diagnosis has become a standard label for assessment data. The Iowa Interventions Project Research Team proposes that Nursing Interventions Classification (NIC) be adopted to label nursing interventions. The author applies NIC to HIV/AIDS nursing care guidelines from the literature and concludes that NIC can be an important tool as HIV/AIDS nurses develop and describe their knowledge base.
Doorenbos, Ardith Z.; Juntasopeepun, Phanida; Eaton, Linda H.; Rue, Tessa; Hong, Elizabeth; Coenen, Amy
Purpose This study aimed to describe the nursing interventions that nurses in Thailand identify as most important in promoting dignified dying. Design This study used a cross-sectional descriptive design. Method A total of 247 Thai nurses completed a paper-and-pencil survey written in Thai. The survey included both demographic questions and palliative care interventions, listed with summative rating scales, from the International Classification for Nursing Practice (ICNP) catalogue Palliative Care for Dignified Dying. Descriptive statistics were used to analyze the data. Findings The five most important nursing interventions to promote dignified dying, ranked by average importance rating, were (a) maintain dignity and privacy, (b) establish trust, (c) manage pain, (d) establish rapport, and (e) manage dyspnea. Conclusions This research identified the palliative care nursing interventions considered most important by nurses in Thailand to promote dignified dying. Implications for Practice The ICNP catalogue Palliative Care for Dignified Dying can be used for planning and managing palliative nursing care in Thailand. PMID:24014487
Wyatt, Gwen K; Donze, Laurie Friedman; Beckrow, Kathryn Christensen
This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing care or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p
Müller, Martin; Bartoszek, Gabriele; Beutner, Katrin; Klingshirn, Hanna; Saal, Susanne; Stephan, Anna-Janina; Strobl, Ralf; Grill, Eva; Meyer, Gabriele
Hintergrund: Gelenkkontrakturen sind häufige Probleme gebrechlicher älterer Menschen in Pflegeheimen. Unabhängig von der genauen Anzahl an älteren Menschen, die an Gelenkkontrakturen leiden, scheint dieses Syndrom ein relevantes Problem im Setting Pflegeheim dazustellen. Durch einen zunehmenden Fokus auf Gelenkkontrakturen, z.B. durch die Pflegeversicherung, kam es zu einem Anstieg im Dokumentations- und Assessmentaufwand und in der Einführung von Präventionsmaßnahmen. Viel mehr Aufmerksamkeit sollte aber auf die tatsächliche Situation der älteren Menschen mit Gelenkkontrakturen in Pflegeheimen gelegt werden, vor allem deren tatsächlichen Einschränkungen in Aktivitäten und Teilhabe. Das Ziel dieser Studie ist daher, 1) die Entwicklung einer maßgeschneiderten Intervention zur Verbesserung der Funktionsfähigkeit, sozialen Teilhabe und Lebensqualität von Menschen mit Gelenkkontrakturen in Pflegeheimen und 2) die Überprüfung der Machbarkeit der Intervention, begleitet von einer Prozessevaluation.Methoden: Die Entwicklung der komplexen Intervention folgt dem UK Medical Research Council (MRC) Framework und integriert die Perspektiven aller potenziell relevanten Benutzergruppen von den betroffenen Personen über Kliniker und Forscher. Der Entwicklungsprozess beinhaltet einen systematischen Literaturreview, die Re-Analyse vorhandener Daten, Fokusgruppeninterviews mit Betroffenen, eine Expertentagung und eine Delphi-Studie mit klinischen Experten sowie eine Cluster-randomisierte Pilotstudie mit umfassender Prozessevaluation. Diskussion: Die geplante Studie wird eine maßgeschneiderte Intervention zur Verbesserung von Funktionsfähigkeit, sozialer Teilhabe und Lebensqualität von Menschen mit Gelenkkontrakturen in Pflegeheimen bereitstellen. Die Pilotstudie inklusive der Prozessevaluation stellt einen ersten Schritt zur Schätzung der Stärke des Interventionseffektes dar und wird weitere Studien vorbereiten.
Meehan, T C
Therapeutic Touch (TT) is being proposed as a nursing intervention. Its proponents claim that it is integral to the art of nursing practice and can facilitate comfort and healing in a wide range of patients. However, the practice of TT is also controversial, primarily because it does not usually involve physical contact and is based on energy field theoretical frameworks. The development of TT and its conceptualization as an energy field interaction are reviewed, and points of controversy discussed. The method of practice is described. Review of controlled efficacy studies indicates limited and inconclusive scientific support for its proposed effects. The intrinsic relationship between TT and the placebo phenomenon is discussed. The potential of TT to enhance the placebo effect requires further exploration but should not be discounted in seeking to relieve discomfort and distress and facilitate healing. For some patients, TT may serve as a beneficial adjuvant nursing intervention.
Liukkonen, A; Vehviläinen-Julkunen, K
The purpose of the study was to describe the childbirth experience of fathers and nursing interventions used during labour and delivery. The data were collected by questionnaires from fathers attending delivery room during one month (n = 137). Five fathers refused to participate. The return rate was 81% out of 132 fathers. Data analysis included cross tabulations, factor analysis as well as content analysis for open ended questions. Nursing interventions which fathers found supportive were infant care, getting information and attention from the staff. Most of the respondents felt they got encouragement to take care of the infant. They also got information of the delivery and newborn's welfare. However, about half felt they got little encouragement to show their own feelings. Fathers found that being present at the delivery was an important part of their fatherhood. The best moments were attached to enjoyment of taking care of the newborn. Fathers felt themselves unable to help their partner enough. They felt very difficult to see their partner in pain. Most of the father were quite satisfied with nursing interventions used during labour. They wanted more attention to be paid to pain management. Fathers would like to get more advice during labour.
Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol)
Koelewijn-van Loon, Marije S; van Steenkiste, Ben; Ronda, Gaby; Wensing, Michel; Stoffers, Henri E; Elwyn, Glyn; Grol, Richard; van der Weijden, Trudy
Background Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management. Methods A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52 weeks. Clinical endpoints will
Lee, Eunjoo; Park, Hyejin; Nam, Mihwa; Whyte, James
The purpose of the study was to identify Nursing Interventions Classification (NIC) interventions performed by Korean school nurses. The Korean data were then compared to U.S. data from other studies in order to identify differences and similarities between Korean and U.S. school nurse practice. Of the 542 available NIC interventions, 180 were…
Farran, C J; Horton-Deutsch, S; Meyer, P M; Bourgard, L
The purpose of this pilot study was to develop and test the Geropsychiatric Intervention Checklist (GPIC), a measure designed to quantify psychosocial nursing interventions provided to persons on a geropsychiatric inpatient unit (N = 48). Data were collected by nursing staff, using self-report methods. This pilot study lays the foundation for future research designed to examine the impact of nursing interventions on geropsychiatric inpatient outcomes.
Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.
Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…
A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol
Stanciu, Marian Andrei; Morris, Caroline; Makin, Matt; Watson, Eila; Bulger, Jenna; Evans, Richard; Hiscock, Julia; Hoare, Zoë; Edwards, Rhiannon Tudor; Neal, Richard David; Wilkinson, Clare
Introduction Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. Methods and analysis Prostate cancer survivors diagnosed in the past 9–48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. Ethics and dissemination Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific
PACE-UP (Pedometer and consultation evaluation - UP) – a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45–75 years: study protocol for a randomised controlled trial
Background Most adults do not achieve the 150 minutes weekly of at least moderate intensity activity recommended for health. Adults’ most common physical activity (PA) is walking, light intensity if strolling, moderate if brisker. Pedometers can increase walking; however, most trials have been short-term, have combined pedometer and support effects, and have not reported PA intensity. This trial will investigate whether pedometers, with or without nurse support, can help less active 45–75 year olds to increase their PA over 12 months. Methods/design Design: Primary care-based 3-arm randomized controlled trial with 12-month follow-up and health economic and qualitative evaluations. Participants: Less active 45–75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. Intervention: The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. Outcomes: Changes in average daily step-count (primary outcome), time spent sedentary and in at least moderate intensity PA weekly at 12 months, measured by accelerometry. Other outcomes include change in body mass index, body fat, self-reported PA, quality of life, mood and adverse events. Cost-effectiveness will be assessed by the incremental cost of the intervention to the National Health Service
de Raad, Johan; van Gool, Kees; Haas, Marion; Haywood, Philip; Faedo, Margaret; Gallego, Gisselle; Pearson, Sallie; Ward, Robyn
New medicines and therapeutic combinations are tested and marketed every year. Healthcare decision makers have to make explicit choices about adopting new treatments and deal with the resource consequences of their choices. The aim of this article is to examine the nursing workload of administering alternative chemotherapy protocols as a driver of costs. Data collection (focus groups with chemotherapy nurses and a survey of nurse unit managers) was conducted to ascertain the time required to undertake chemotherapy-related tasks and the sources of variability in six chemotherapy centers in New South Wales, Australia. Four task types (patient education, patient assessment, administration, and patient communication) were identified as being associated with administering chemotherapy. On average, patient education required 48 minutes during the first visit and 18.5 minutes thereafter, patient assessment took 20.3 minutes, administration averaged 23 minutes, and patient communication required 24.2 minutes. Each center treated an average of 14 patients per day. Each patient received 3.3 hours of staff time (1.7 hours of direct contact time and 1.6 hours of noncontact time). The result of this research will allow healthcare decision makers and evaluators to predict the amount of nursing time required to administer chemotherapy based on the characteristics of a wide range of chemotherapy protocols.
A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial
Background Heart failure is a prevalent health problem associated with costly hospital readmissions. Transitional care programs have been shown to reduce readmissions but are costly to implement. Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed. The objective of this randomized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure. Methods/Design A multi-center, randomized controlled trial is being conducted at six academic health systems in California. A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure. Patients in the intervention group will receive intensive patient education using the ‘teach-back’ method and receive instruction in using the telemonitoring equipment. Following hospital discharge, they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a centralized call center. The nurses also will call patients and patients’ physicians in response to alerts generated by the telemonitoring system, based on predetermined parameters. The primary outcome is readmission for any cause within 180 days. Secondary outcomes include 30-day readmission, mortality, hospital days, emergency department (ED) visits, hospital cost, and health-related quality of life. Discussion BEAT-HF is one of the largest randomized controlled trials of telemonitoring in patients with heart failure, and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring. The study population also includes patients with a
Lee, Eunjoo; Park, Hyejin; Nam, Mihwa; Whyte, James
The purpose of the study was to identify Nursing Interventions Classification (NIC) interventions performed by Korean school nurses. The Korean data were then compared to U.S. data from other studies in order to identify differences and similarities between Korean and U.S. school nurse practice. Of the 542 available NIC interventions, 180 were selected as the basis of a questionnaire designed to quantify key aspects of school nursing practice. The data were collected from 131 school nurses working in Korea. The results indicated that Korean school nurses focused on classifications from the Physiological Basic domain. Comparisons to previously reported U.S. data reflect that U.S. school nurses focus primarily on the Behavioral domain. The data reflect important differences between the practice characteristics of Korean and U.S. school nurses. Further, the data support the utility of NICs in quantifying the practice characteristics of school nurses in Korea.
Siddell, Erica; Marinelli, Kathleen; Froman, Robin D; Burke, Georgine
The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.
Rieder, Barbara A.
The role of public health nurses in the health care of infants and children prenatally exposed to drugs is discussed. Such nurses work in the family setting to promote health and prevent disease. Concepts of Kathryn Barnard have been used to develop policies and protocols for services to families with infants exposed to controlled substances. (GH)
VanBever Wilson, Robin R.
Due to the complex challenges facing schools of nursing, a research study was implemented to introduce nurse faculty at one small rural northeastern Tennessee school of nursing to the NLN "Core Competencies for Nurse Educators". Utilizing Kalb's Nurse Faculty Self-Evaluation Tool as a pre- and post-intervention test, 30 nurse faculty members…
Redes, S; Lunney, M
Validation of standardized nursing language for use by specialty nurses is important for the design of computer software. The purposes of this study were to validate the usefulness of the 433 interventions in the Nursing Intervention Classification (NIC) for school nurses and to identify interventions that could be omitted from computer software for school nurses. A school nursing listserv, SCHLRN-L, was used to recruit volunteers. Ninety-three volunteers from the listserv also recruited 26 school nurses who were not members of the listserv. The total sample was 102 school nurses from 25 states and other areas, 76 listserv volunteers, and 26 others. E-mail was used to send and receive the survey forms to portions of the sample. A majority of interventions (n = 241; 56%) were selected as used by more than 50% of the sample. Of these, 53 direct care interventions were selected as used by more than 80% of the sample. Fifty interventions were not used by 100% of the sample. E-mail was a useful means to obtain a national sample and collect data. PMID:9401199
Redes, S; Lunney, M
Validation of standardized nursing language for use by specialty nurses is important for the design of computer software. The purposes of this study were to validate the usefulness of the 433 interventions in the Nursing Intervention Classification (NIC) for school nurses and to identify interventions that could be omitted from computer software for school nurses. A school nursing listserv, SCHLRN-L, was used to recruit volunteers. Ninety-three volunteers from the listserv also recruited 26 school nurses who were not members of the listserv. The total sample was 102 school nurses from 25 states and other areas, 76 listserv volunteers, and 26 others. E-mail was used to send and receive the survey forms to portions of the sample. A majority of interventions (n = 241; 56%) were selected as used by more than 50% of the sample. Of these, 53 direct care interventions were selected as used by more than 80% of the sample. Fifty interventions were not used by 100% of the sample. E-mail was a useful means to obtain a national sample and collect data.
Smedley, Alison; Crawford, Tonia; Cloete, Linda
Plagiarism is a current and developing problem in the tertiary education sector where students access information and reproduce it as their own. It is identified as occurring in many tertiary level degrees including nursing and allied health profession degrees. Nursing specifically, is a profession where standards and ethics are required and honesty is paramount. The aim of this study was to evaluate the change in nursing student's knowledge and understanding of plagiarism before and after an educational intervention in their first semester of the Bachelor of nursing degree at a private college of higher education in Sydney, Australia. This study concluded that an educational intervention can increase knowledge and awareness of plagiarism among nursing students.
Fitzwater, Evelyn L; Gates, Donna M
Nursing home staffs frequently encounter physical and emotional violence directed toward them by residents. This article addresses the problem from an occupational health perspective and describes a pilot study focused an educational intervention to reduce resident assaults on certified nursing assistants (CNAs) in nursing homes. After a 4-hour education intervention, the study CNAs reported fewer physical assaults by residents and increased levels of knowledge and confidence in their ability to manage residents' aggressive behavior compared with a similar CNA group. Limitations include a small convenience sample who works only the day shift. Results support education and training as effective in reducing resident physical assaults and enhancing nursing home safety. Further research should investigate assaultive resident behavior and evaluate the effectiveness of interventions to prevent, reduce, and manage violence in nursing homes. PMID:11865253
Tucker, Sharon; Farrington, Michele; Lanningham-Foster, Lorraine M; Clark, M Kathleen; Dawson, Cindy; Quinn, Geralyn J; Laffoon, Trudy; Perkhounkova, Yelena
Health behaviors, including physical activity (PA), of registered nurses (RNs) and medical assistants (MAs) are suboptimal but may improve with worksite programs. Using a repeated-measures crossover design, the authors explored if integrating a 6-month worksite non-exercise activity thermogenesis (NEAT) intervention, with and without personalized health coaching via text messaging into workflow could positively affect sedentary time, PA, and body composition of nursing staff without jeopardizing work productivity. Two ambulatory clinics were randomly assigned to an environmental NEAT intervention plus a mobile text message coaching for either the first 3 months (early texting group, n = 27) or the last 3 months (delayed texting group, n = 13), with baseline 3-month and 6-month measurements. Sedentary and PA levels, fat mass, and weight improved for both groups, significantly only for the early text group. Productivity did not decline for either group. This worksite intervention is feasible and may benefit nursing staff. PMID:27143144
Mackenzie, Corey S; Poulin, Patricia A; Seidman-Carlson, Rhonda
Whereas the causes and negative consequences of stress among nurses are well known, less is known about effective ways to reduce or prevent this growing problem. Mindfulness-based stress reduction programs are proving to be effective in reducing stress and improving health in a variety of clinical populations. A smaller body of evidence suggests that these programs are also effective for nonclinical populations at risk for stress-related health problems. This study involved the development and evaluation of a brief 4-week mindfulness intervention for one such group-nurses and nurse aides. In comparison with 14 wait-list control participants, 16 participants in the mindfulness intervention experienced significant improvements in burnout symptoms, relaxation, and life satisfaction. The results of this pilot study, together with a natural fit between mindfulness philosophy and nursing practice theory, suggest that mindfulness training is a promising method for helping those in the nursing profession manage stress, even when provided in a brief format.
The purpose of this qualitative analysis is to elucidate more fully telephone social support as it was delivered within the context of a randomized controlled investigation. To this end, the author used constant comparative methods to analyze telephone logs. The findings are congruent with the operational definition of social support that was selected for the randomized controlled study; however, they are also suggestive of nursing presence. Components of nursing presence that emerged from the data include (a) maintenance of psychological presence, (b) interpersonal reciprocity characterized by a mutual desire to work together, (c) therapeutic communication and full attention to the here and now, and (d) expert nursing practice within the nurse-patient dyad. Outcomes include problem solving, adaptive behavior change, and diminished distress. Researchers are encouraged to continue to use qualitative methods to define and differentiate the concepts of social support and nursing presence more clearly. This is particularly important as the demand for empirically based nursing interventions grows.
Selekman, Janice; Thomas, Elizabeth; McLean, Kay
Describes the practices of homeopathy and how they affect the scope of practice of school nurses. Includes a definition of homeopathy, a discussion of remedies and the specific symptoms for which they are effective, and an examination of conditions treatable by homeopathic physicians. Nine guidelines for managing homeopathic products in the school…
Assis, Melissa Nardini de; Andrade, Ana Caroline Ramirez de; Rogenski, Karin Emília; Castilho, Valéria; Fugulin, Fernanda Maria Togeiro
Objective To identify and validate interventions/activities developed by a nursing team in a Brazilian pediatric unit. Method A descriptive, cross-sectional, and observational study was developed in the pediatric clinic of the university hospital of University of São Paulo, São Paulo, Brazil. It was organized in the following stages: identifying activities carried out by the team (from records in patient charts and from direct observation); mapping out and validating activities identified in interventions according to the Nursing Intervention Classification (NIC). Results The 275 identified activities were mapped out into 63 interventions, 22 NIC classes and 7 NIC domains, and 25 associated and 13 personal activities. After validation, the number of activities decreased to 244, corresponding to 53 interventions, 20 NIC classes and 6 NIC domains, and 30 associated activities and 9 personal activities. Conclusion Identifying the interventions/activities performed by the nursing team can help measure workload and is an important contribution to overcoming difficulties when it comes to operationalizing the process of sizing professional teams in the field of pediatrics. PMID:26959158
Sprangers, Suzan; Dijkstra, Katinka; Romijn-Luijten, Anna
Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides' communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides' (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides' communication, caregiver distress, and job satisfaction and residents' psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.
Perkins, Kenneth A.; And Others
Used a behavioral intervention of goal-setting with feedback and contingent reinforcement to increase stationary bike riding in eight male nursing home residents with multiple major medical and psychiatric disorders. A consistent increase in riding resulted among all participants. Findings support the effectivenes of behavioral strategies in…
Torralbas-Ortega, Jordi; Puntí-Vidal, Joaquim; Arias-Núñez, Eloisa; Naranjo-Díaz, M Carmen; Palomino-Escrivá, Jezabel; Lorenzo-Capilla, Angel
One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results.
McCauley, Kathleen; Bradway, Christine; Hirschman, Karen B; Naylor, Mary D
Background Between one and two of every five hospitalized older adults have cognitive deficits, often not accurately assessed or well managed. Cognitive impairment adds substantially to the complexity of these patients’ care, places them at high risk for poor outcomes and increases the cost of health care. Methods We describe three evidence-based interventions, each capitalizing on the unique contributions of nurses and designed to improve outcomes of hospitalized older adults who have cognitive deficits. Interventions of varying intensity were compared across three hospitals (Phase I) and subsequently within the same hospitals (Phase II). All enrolled patients were screened during their index hospitalizations and cognitive deficits were communicated to relevant health care team members (Augmented Standard Care-ASC, lowest intensity). At one hospital, ASC was the only intervention. Patients at a second hospital also had care influenced by specially prepared registered nurses (Resource Nurse Care-RNC, medium intensity). Finally, patients at third hospital also received advanced practice nurse coordinated care (Transitional Care Model-TCM, higher intensity). In Phase II, newly enrolled patients at these same hospitals all received the TCM. We summarize major themes from review of multiple data sources and researcher recollections related to facilitators and barriers to implementing a complex research study. Findings Effective implementation of the three intervention strategies depended on clinician engagement and communication; degree of participation by nurses in the educational program with subsequent practice improvement; and success of advanced practice nurses in implementing the TCM with both with patients, family caregivers and clinicians. Implications Based on lessons learned in implementing complex research studies within the “real world” of clinical practice settings, recommendations focus on strengthening facilitators, minimizing barriers and gaining
Dodgson, Joan E; Tarrant, Marie
Educational institutions have the responsibility to provide students with knowledge and practical experiences of best practices and international standards of care. Worldwide, international standards for appropriate and effective breastfeeding promotion and services often have not been met. The aim of this study was to determine the effectiveness of an infant feeding educational intervention on student nurses' knowledge levels about (1) evidence-based breastfeeding promotion, (2) evidence-based beliefs about outcomes of breastfeeding and formula-feeding, (3) evidence-based attitudes toward breastfeeding and formula-feeding, and (4) intention to perform evidence-based breastfeeding promotion behaviors. A quasi-experimental intervention with a non-equivalent control group was conducted at a major university in Hong Kong. The intervention group (n=111) received 10h of didactic instruction and an 8-week perinatal clinical rotation while the control group (n=162) did not. The intervention group was significantly more likely to associate breastfeeding with positive maternal and child outcomes. Attitudes toward breastfeeding and formula-feeding were not significantly affected by the educational intervention. On the 19-item knowledge survey, the control group (M=6.84; SD=2.95) scored significantly lower than the intervention group (M=10.30; SD=2.51). A public health breastfeeding promotion strategy frequently overlooked is professional-level curricular interventions. Improving evidence-based practices in nursing programs has the potential to impact many breastfeeding families in the hospital and the community.
Nicotera, Anne Maydan; Mahon, Margaret M; Wright, Kevin B
Quality communication is essential for building strong nursing teams. Structurational divergence (SD) theory explains how institutional factors can result in poor communication and conflict cycles; the theory has been developed in nursing context, although it is applicable to all organizational settings. We describe the design, implementation, and evaluation of an intervention to reduce SD and improve nurses' work life and team-member relationships. An intensive 9-hour course provided training in conflict/SD analysis and dialogic conflict/SD management to 36 working nurses from a variety of settings. Quantitative pre- and posttests were administered, with a comparison sample. The course reduced measures of negative conflict attitudes and behaviors: direct personalization, persecution feelings, negative relational effects, ambiguity intolerance, and triangulation (gossiping and complaining to uninvolved third parties). The course also increased important attitudes necessary for productive dialogue and conflict management: perceptions of positive relational effects, conflict liking, and positive beliefs about arguing. As compared with nonparticipants, participant posttests showed lower conflict persecution; higher recognition of positive relational effects; lower perceptions of negative relational effects; higher conflict liking; lower ambiguity intolerance; and lower tendency to triangulate. Qualitatively, participants perceived better understanding of, and felt more empowered to manage, workplace conflicts and to sustain healthier workplace relationships. This intervention can help nurses develop tools to improve system-level function and build productive team relationships.
Baghaei, Rahim; Sharifian, Elham; Kamran, Aziz
Background Hand washing is the best strategy to prevent known nosocomial infections but the nurses’ hand hygiene is estimated to be poor in Iran. Objective This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education. Methods This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher’s exact tests. The significance level was considered P<0.05. Results The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16). Conclusion Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses. PMID:27366106
Shah, Shilpa M.; Heylen, Elsa; Srinivasan, Krishnamachari; Perumpil, Sheeja; Ekstrand, Maria L.
HIV stigma can be devastating and is common among health care providers, particularly nurses. The objectives of this study were to (a) assess the acceptability and feasibility of a brief stigma-reduction curriculum among a convenience sample of Indian nursing students and (b) examine the preliminary effect of this curriculum on their knowledge, attitudes, and intent to discriminate. At baseline, 57% of students had at least one misconception about HIV transmission, 38% blamed people living with HIV for their infection, and 87% and 95% demonstrated intent to discriminate while dispensing medications and drawing blood, respectively. Following the curriculum, HIV-related knowledge increased while blame, endorsement of coercive policies, and intent to discriminate decreased significantly. In addition, more than 95% of participants described the curriculum as practice changing. This brief intervention resulted in decreased stigma levels and was also highly acceptable to the nursing students. Next steps include rigorous evaluation in a randomized controlled trial. PMID:24569699
Redland, Alice R.
The purpose of this study was to identify relations between nurses' interaction styles and patient care interventions (PCI) that occurred after nurse-doctor interactions. A nonparticipant observer recorded interactions of 48 female registered nurses with physicians. Transcripts were coded and assigned to one of five theoretical nurse interaction…
Moss, Jacqueline; Saba, Virginia
The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.
Kaitani, Toshiko; Nakagami, Gojiro; Iizaka, Shinji; Fukuda, Takashi; Oe, Makoto; Igarashi, Ataru; Mori, Taketoshi; Takemura, Yukie; Mizokami, Yuko; Sugama, Junko; Sanada, Hiromi
The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.
Maruca, Annette T; Shelton, Deborah
The authors explore the current state-of-the art of correctional nursing by summarizing the types of interventions employed by nurses, across studies, designed to assist this challenging group of patients. This examination of evidence-based interventions implemented and tested by correctional nurses provides a better understanding of their role and function. Correctional health is a nurse driven system, yet a minimal amount is known about the nurses who practice in these environments or about their contributions to the practice of mental health nursing in correctional environments. An integrative review utilizing PRISMA guidelines examined five databases (Medline/PubMed, PsycInfo, PsychArticles, Sage Criminology, and Academic Search) for peer-reviewed articles that fit selected criteria. Of 324 references identified, 16 studies met criteria. Following assessment of strength of evidence, only eight studies offered scientific proof of the effectiveness of nursing interventions. Nursing interventions implemented in correctional settings targeted incarcerated persons with behavioral and psychological symptoms. Interventions included psycho-education, environmental adaptations, and behavior therapies. The centrality of nurses in correctional health care emphasizes the significance of understanding their role and function in this setting. This integrative review revealed that correctional nurses are actively engaged in providing therapeutic, evidence-based interventions in the health care of incarcerated persons. Of interest, seven of the eight studies focused on incarcerated persons with mental health or substance use issues. Nurse led interventions such as CBT, labyrinth walking, and yoga aim to improve coping and adaptation of incarcerated persons. PMID:27049171
Robbins, B T
The nursing profession is moving toward developing a standardized language. Benefits of such a language are outlined. Nursing Interventions Classification (NIC) (Iowa Intervention Project, 1992), a standardized language for nursing interventions, has been recently developed by the Iowa Intervention Project. This article describes how NIC was incorporated into a nursing care plan in a tertiary acute care facility. Teaching strategies, which include aspects of adult learning theory and motivational theory, are discussed. Utilization of creativity and variability in the planning and implementation of a unit based inservice program were the most beneficial strategies used.
Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Psychosocial Effects of Cancer and Its Treatment; Therapy-related Toxicity
Almeida, Miriam de Abreu; Longaray, Vanessa Kenne; De Cezaro, Paula; Barilli, Sofia Louise Santin
The objective of this work was to compare the care prescribed by nurses for orthopedic surgery patients after surgery with the interventions and activities proposed by the Nursing Interventions Classification (NIC), in order to verify its agreement. The study was carried out at the Hospital de Clinicas de Porto Alegre (a University hospital in the south of Brazil), using the mapping technique. Data on the 170 studied patients were obtained by the Computerized Nursing Prescription System. The 52 care forms related to nursing diagnosis (ND) Self-Care Deficit--bath and/or hygiene, Impaired Physical Mobility and Risk of Infection--were mapped with 33 nursing interventions, contained in 14 classes and 4 Domains. The comparison between nursing prescriptions and the interventions proposed by the NIC for the 3 ND studied evidenced there is agreement among them. We considered that the NIC may become an important source of consultation to improve and to base nursing care.
Yang, Hsiao-Ling; Lou, Meei-Fang; Liu, Pei-Ching; Ni, Lee-Fen; Chang, Hao-Yuan; Chen, Yueh-Chih
This study reviewed historical nursing intervention studies in Taiwan and analyzed results based on sample characteristics, methodology characteristics, and content characteristics. Historical studies were split into four groups, G1970, G1980, G1990, and G2000, based on the decade in which they were published. A comparison was then made to identify significant differences between G2000 and other groups. A total of 103 nursing intervention studies were analyzed in this study. Results included sample characteristics of studies conducted primarily by single-disciplinary research teams, although multidisciplinary studies showed a growth trend across decades, with the number of multidisciplinary studies significantly greater in G2000 than in other decades. Nursing practice was the main area of research, clients were the major participants studied, and hospitals provided the principal research setting. No statistical difference was noted in the above mentioned variables. In terms of methodology characteristics, questionnaires were used most frequently to collect data. A quasi-experimental design was the primary research design employed. Although the number of experimental designs has increased significantly in recent years, most studies specified their inclusion criteria. Reliability and validity of instruments were more clearly specified in recent decade groups than in earlier decade groups. Methodology rigor has improved in recent years, achieving a statistically significant difference between G2000 and other groups in all categories, with the exception of instrument validity. In terms of content characteristics, health education was the leading intervention type. Most interventions were categorized as tertiary prevention, with perceptual outcome used most often as the outcome indicator. However, no statistical differences in content dimension variables were identified between G2000 and other groups. In summary, the number of nursing intervention research cases has
Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura
Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.
Porter, Gloria; Edwards, Pamela B; Granger, Bradi B
To gain insight into high school students' perceptions of the role of the nurse and to explore students' impressions of nursing following a nurse-shadowing intervention. Often nurses abandon staffing positions in the first 1-2 years, reporting a "poor fit" with nursing. Few studies have examined expectations and perceptions of nursing among high school students; a population of potential nurses in whom a more accurate view of nursing opportunities and professionalism may be fostered. High school students from two North Carolina counties participated in a nurse-shadowing intervention. Constant comparison and thematic coding were used for analysis of post-intervention in-depth interviews. Sixteen of 24 students completed the study. Misperception of nursing was the dominant theme. Five sub-themes were professional role responsibility, teamwork, caring relationships, tools and technology, and medication management. Experiential knowledge of nursing was a core need for students interested in nursing careers. These data suggest that a nurse shadowing program may positively influence perceptions of nursing, and may result in improved recruitment and retention in the workplace.
This paper gives an account of an innovative educational programme developed by the Department of Midwifery Studies at the University of Central Lancashire (UCLAN) in 1995. The North West Regional Health Authority (NWRHA) approached the Department of Midwifery Studies to develop an educational programme for family planning nurses to supply the combined method of emergency hormonal contraception (EHC) under protocol when a doctor was not present. The purpose was to increase the availability and accessibility of EHC for young people in the North West region. The 3-day programme was designed to complement previous ENB 901/900 training, and also to provide the nurses with the specific skills and knowledge required to undertake this new role. One hundred and thirty-nine nurses from the North West area attended the programme between 1995-1998. Students were assessed both theoretically and clinically. Extending the role of family planning nurses to supply EHC gives purchasers and providers of sexual health care the potential to offer a wider range of accessible services. The recently published interim Crown Report1 on the supply and administration of medicines under group protocols states that protocols should specify clear arrangements for professional responsibility and accountability. Appropriate training is essential to ensure that the extended role of the nurse in family planning is fully understood.
Spinks, Jean; Chaboyer, Wendy; Bucknall, Tracey; Tobiano, Georgia; Whitty, Jennifer A
Introduction Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care. It is important to consider the preferences of both patients and nurses when implementing bedside handover to maximise the successful uptake of this policy. We outline a study which aims to (1) identify, compare and contrast the preferences for various aspects of handover common to nurses and patients while accounting for other factors, such as the time constraints of nurses that may influence these preferences.; (2) identify opportunities for nurses to better involve patients in bedside handover and (3) identify patient and nurse preferences that may challenge the full implementation of bedside handover in the acute medical setting. Methods and analysis We outline the protocol for a discrete choice experiment (DCE) which uses a survey design common to both patients and nurses. We describe the qualitative and pilot work undertaken to design the DCE. We use a D-efficient design which is informed by prior coefficients collected during the pilot phase. We also discuss the face-to-face administration of this survey in a population of acutely unwell, hospitalised patients and describe how data collection challenges have been informed by our pilot phase. Mixed multinomial logit regression analysis will be used to estimate the final results. Ethics and dissemination This study has been approved by a university ethics committee as well as two participating hospital ethics committees. Results will be used within a knowledge translation framework to inform any strategies that can be used by nursing staff to improve the uptake of bedside handover. Results will also be disseminated via peer-reviewed journal articles and will be presented at national and international conferences. PMID:26560060
Tosin, Michelle Hyczy de Siqueira; Campos, Débora Moraes; de Andrade, Leonardo Tadeu; de Oliveira, Beatriz Guitton Renaud Baptista; Santana, Rosimere Ferreira
ABSTRACT Objective: to perform a cross-term mapping of nursing language in the patient record with the Nursing Interventions Classification system, in rehabilitation patients with Parkinson's disease. Method: a documentary research study to perform cross mapping. A probabilistic, simple random sample composed of 67 records of patients with Parkinson's disease who participated in a rehabilitation program, between March of 2009 and April of 2013. The research was conducted in three stages, in which the nursing terms were mapped to natural language and crossed with the Nursing Interventions Classification. Results: a total of 1,077 standard interventions that, after crossing with the taxonomy and refinement performed by the experts, resulted in 32 interventions equivalent to the Nursing Interventions Classification (NIC) system. The NICs, "Education: The process of the disease.", "Contract with the patient", and "Facilitation of Learning" were present in 100% of the records. For these interventions, 40 activities were described, representing 13 activities by intervention. Conclusion: the cross mapping allowed for the identification of corresponding terms with the nursing interventions used every day in rehabilitation nursing, and compared them to the Nursing Interventions Classification. PMID:27508903
Koczy, P; Klie, T; Kron, M; Bredthauer, D; Rissmann, U; Branitzki, S; Guerra, V; Klein, A; Pfundstein, T; Nikolaus, Th; Sander, S; Becker, C
At present, observational studies and expert opinion are the best evidence for the use of physical restraints. Large regional and national disparities are described in acute and long-term care. Epidemiological data demonstrate a prevalence of 3-5% body-fixed or near body restraint devices. The hip fracture rate in Germany are approximately 50 per 1000 resident years. Between 40-50% of the residents in nursing homes are treated with psycho-tropic medication potentially limiting their physical mobility. The presented study protocol was designed to test the effectiveness of a multifactorial intervention to reduce physical restraints in long-term care (LTC) residents particularly with cognitive impairment. The intervention consists of an educational and an organizational part to empower staff members to improve their skills and practice in using restraints. Technical devices to reduce fall related injuries are additionally offered to the LTC facilities. The study population includes 200 LTC residents in 54 facilities in three states in Germany. The sample size calculation was based upon a 5% prevalence rate in the control group and an expected reduction of 50% in the intervention group. The protocol is a waiting-list control design. All waiting facilities will be offered to participate after their waiting period. Primary endpoints are the number of restrained residents and resident time (hours) of being restrained. The use of psychotropics, falls, fall-related injuries and the incidence of residents newly being restrained is being monitored. The study starts with a baseline documentation of all facilities followed by randomization and a three month intervention. Change agents will be responsible for the intervention. Technical devices will include a newly developed soft hip protector and sensor mats which notice the intent of leaving the bed. The aim of the study is to develop an evidence-based model for a knowledge transfer project to implement minimum restraint
McDonald, Anne; Frazer, Kate; Duignan, Catriona; Healy, Marianne; Irving, Annette; Marteinsson, Patricia; Molloy, Brenda; McNicholas, Elizabeth
Illuminating the full range of nursing actions is a challenge for nurses globally; the invisibility of nursing and of public health nursing in particular is well documented. Visibility can be enhanced by identifying core functions of nursing and matching corresponding levels of interventions and outcomes. This is a priority for the contemporary Irish public health nursing (PHN) service. In the United States, public health nurses have developed an 'Intervention Wheel' naming public health interventions at community, systems and individual/family levels. This aimed to make visible the core functions of PHN practice. The values and beliefs underpinning the Intervention Wheel have been shown to capture the essence of public health nursing within the European context. In total, US nurses described 17 Wheel interventions by recording stories from practice. Owing to concern that the public health aspect of their role was not only invisible but was at risk of erosion, Irish PHNs decided to replicate this storytelling approach to provide evidence for and authenticate the 17 interventions on the Intervention Wheel from their day-to-day public health practice. PMID:25754782
McDonald, Anne; Frazer, Kate; Duignan, Catriona; Healy, Marianne; Irving, Annette; Marteinsson, Patricia; Molloy, Brenda; McNicholas, Elizabeth
Illuminating the full range of nursing actions is a challenge for nurses globally; the invisibility of nursing and of public health nursing in particular is well documented. Visibility can be enhanced by identifying core functions of nursing and matching corresponding levels of interventions and outcomes. This is a priority for the contemporary Irish public health nursing (PHN) service. In the United States, public health nurses have developed an 'Intervention Wheel' naming public health interventions at community, systems and individual/family levels. This aimed to make visible the core functions of PHN practice. The values and beliefs underpinning the Intervention Wheel have been shown to capture the essence of public health nursing within the European context. In total, US nurses described 17 Wheel interventions by recording stories from practice. Owing to concern that the public health aspect of their role was not only invisible but was at risk of erosion, Irish PHNs decided to replicate this storytelling approach to provide evidence for and authenticate the 17 interventions on the Intervention Wheel from their day-to-day public health practice.
Gauthier, Tina; Meyer, Rika M L; Grefe, Dagmar; Gold, Jeffrey I
The feasibility of a 5-minute mindfulness meditation for PICU nurses before each work-shift to investigate change in nursing stress, burnout, self-compassion, mindfulness, and job satisfaction was explored. Thirty-eight nurses completed measures (Nursing Stress Scale, Maslach Burnout Inventory, Mindfulness Attention Awareness Scale and Self-Compassion Scale) at baseline, post-intervention and 1 month after. The intervention was found to be feasible for nurses on the PICU. A repeated measures ANOVA revealed significant decreases in stress from baseline to post intervention and maintained 1 month following the intervention. Findings may inform future interventions that support on-the-job self-care and stress-reduction within a critical care setting.
Worthington, Catherine A.; O’Brien, Kelly K.; Mill, Judy; Caine, Vera; Solomon, Patty; Chaw-Kant, Jean
We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6- to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre- and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care. PMID:27039195
Masten, Yondell; Conover, Katherine P.
Utilization of computer networks to provide instruction for health care providers and patients can increase knowledge for the participants and reduce the disadvantages of current methods of instruction, i.e., sporadic, inconsistent, hurried instruction patterns. Nursing protocols and nursing and patient education modules were developed as components of KARENET (Kellogg Affiliated Remote Environments Network), linking rural Morton, Texas, and the Health Sciences Center at Lubbock. Both health care providers and patient participants benefit from utilization of knowledge provided by the methodology of CAI/CMI.
Benner, Gregory J.; Nelson, J. Ron; Sanders, Elizabeth A.; Ralston, Nicole C.
This article examined the efficacy of a primary-level, standard-protocol behavior intervention for students with externalizing behavioral disorders. Elementary schools were randomly assigned to treatment (behavior intervention) or control (business as usual) conditions, and K-3 students were screened for externalizing behavior risk status. The…
Vézina, Aline; Robichaud, Line; Voyer, Philippe; Pelletier, Daniel
This study examines the identity cues that family caregivers and healthcare personnel use with seniors living with dementia and living in nursing homes. The identity cues represent biographical knowledge used to stimulate the dementia sufferer, trigger signals and incite interaction. Our grounded approach hinges on three objectives: to identify and categorize identity cues; to document their uses; and to gain a better understanding of their effectiveness. We interviewed nine family caregivers and 12 healthcare workers. Qualitative data indicates that the participants use identity cues that evoke seniors' sociological, relational and individual characteristics. These identity cues play a central role in communication and constitute important information that the family caregivers can share with healthcare personnel. They sustain memory, facilitate care and reinforce seniors' self-value. These results help to define identity, foster a greater role for family caregivers, and constitute a sound basis for the implementation of personalized interventions.
Pierik, Jorien G J; Berben, Sivera A; IJzerman, Maarten J; Gaakeer, Menno I; van Eenennaam, Fred L; van Vugt, Arie B; Doggen, Carine J M
While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P < 0.05), whereas time to opioids decreased from 37 to 15 min (P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management. PMID:26968352
Tanner, Andrea; Clarke, Carrie
In response to limited direction given by legislative bodies to school nurses about how to implement state-mandated or recommended stock epinephrine programs in their schools, NASN convened a workgroup of invested stakeholders. This workgroup was challenged to equip school nurses with the necessary tools to develop policies and protocols regarding stock epinephrine in their school districts. The dynamic workgroup subcommittees focused on policies, procedures, and reporting tools. This article reviews the results of the subcommittees' work and the overall collaboration within the workgroup. This article provides clear, nationally recognized guidance on the best practice for establishing stock epinephrine policies and protocols with reporting tools at the local school district level. PMID:26739930
Escallier, Lori A; Fullerton, Judith T
Program evaluations in schools of nursing (SONs) serve the purpose of clearly demonstrating how the SON meets the quality standards established by governance, regulatory, and accreditation bodies. The authors describe the step-by-step process taken by a SON to develop a new model of an evaluation protocol that includes linkages to external criteria for evaluation of the plan itself. This analysis and feedback step is often neglected but is essential to the quality improvement process.
Furberg, Robert D; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A
Background Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Objective Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. Methods The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care–related infections were reviewed to develop the infection control protocol to support tablet maintenance. Results This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. Conclusions These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings. PMID:27350013
Doran, Diane; Clarke, Sean; Hayes, Laureen; Nincic, Vera
Much has been written about interventions to improve the nursing work environment, yet little is known about their effectiveness. A Delphi survey of nurse experts was conducted to explore perceptions about workplace interventions in terms of feasibility and likelihood of positive impact on nurse outcomes such as job satisfaction and nurse retention. The interventions that received the highest ratings for likelihood of positive impact included: bedside handover to improve communication at shift report and promote patient-centred care; training program for nurses in dealing with violent or aggressive behaviour; development of charge nurse leadership team; training program focused on creating peer-supportive atmospheres and group cohesion; and schedule that recognizes work balance and family demands. The overall findings are consistent with the literature that highlights the importance of communication and teamwork, nurse health and safety, staffing and scheduling practices, professional development and leadership and mentorship. Nursing researchers and decision-makers should work in collaboration to implement and evaluate interventions for promoting practice environments characterized by effective communication and teamwork, professional growth and adequate support for the health and well-being of nurses. PMID:25676080
Doran, Diane; Clarke, Sean; Hayes, Laureen; Nincic, Vera
Much has been written about interventions to improve the nursing work environment, yet little is known about their effectiveness. A Delphi survey of nurse experts was conducted to explore perceptions about workplace interventions in terms of feasibility and likelihood of positive impact on nurse outcomes such as job satisfaction and nurse retention. The interventions that received the highest ratings for likelihood of positive impact included: bedside handover to improve communication at shift report and promote patient-centred care; training program for nurses in dealing with violent or aggressive behaviour; development of charge nurse leadership team; training program focused on creating peer-supportive atmospheres and group cohesion; and schedule that recognizes work balance and family demands. The overall findings are consistent with the literature that highlights the importance of communication and teamwork, nurse health and safety, staffing and scheduling practices, professional development and leadership and mentorship. Nursing researchers and decision-makers should work in collaboration to implement and evaluate interventions for promoting practice environments characterized by effective communication and teamwork, professional growth and adequate support for the health and well-being of nurses.
Lavoie, Patrick; Pepin, Jacinthe; Cossette, Sylvie
To provide optimal care, nurses need to be prepared to recognize signs and symptoms of patient deterioration so they can obtain assistance from appropriate respondents and initiate rescue interventions when needed. In this paper, we describe the development of a post-simulation educational intervention aimed at improving nurses' and nursing students' recognition and response to patient deterioration. This intervention takes the form of a debriefing after a simulated patient deterioration experience. Following the Medical Research Council's guidance on complex interventions, we reviewed empirical studies of existing educational interventions for content, teaching strategies, and outcomes, as well as for frameworks, theoretical underpinnings, and rationale. Based on those results, we reviewed theoretical literature (Tanner's clinical judgment model and Dewey's theory of experiential learning) that might inform our understanding of our intervention's intended effect (learning outcomes) and of the mechanisms by which the intervention could lead to it. Integrating results from the empirical and theoretical phases helped us define the new intervention's rationale and develop its components according to relevant standards of best practices. The resulting educational intervention, REsPoND, consists in a reflective debriefing after a patient deterioration simulation. It will be tested in an upcoming mixed methods study.
Johnson, Pamela; Gilman, Anna; Lintner, Alicia; Buckner, Ellen
Translating evidence-based practices to the bedside can be facilitated by an active academic-practice partnership between nursing faculty and frontline nursing staff. A collaborative effort between the university's academic nurses and the medical center's clinical nurses explored, created, implemented, and evaluated an evidence-based nurse-driven protocol for decreasing the rate of catheter-associated urinary tract infections. The nurse-driven protocol was piloted in 4 intensive care units and included nurse-driven orders for catheter discontinuation, utilization of smaller bore urinary catheters, addition of silver-based cleansing products for urinary catheter care, and education of staff on routine catheter care and maintenance. Data were collected for more than 8 months pre- and postimplementation of the nurse-driven protocol. Postimplementation data revealed a 28% reduction in catheter-associated urinary tract infections in the intensive care units as compared with preimplementation. Secondary benefits of this academic-practice partnership included strengthening the legitimacy of classroom content as lessons learned were integrated into courses in the nursing curriculum. The result of the partnership was a stronger sense of collaboration and collegiality between hospital staff and the university faculty. Transformative leadership engaged numerous stakeholders through collaborative efforts to realize best practices. An academic-practice partnership facilitates transformative change and provides structural stability and sustainability. PMID:27575798
Background Nursing work environments (NWEs) in Canada and other Western countries have increasingly received attention following years of restructuring and reported high workloads, high absenteeism, and shortages of nursing staff. Despite numerous efforts to improve NWEs, little is known about the effectiveness of interventions to improve NWEs. The aim of this study was to review systematically the scientific literature on implemented interventions aimed at improving the NWE and their effectiveness. Methods An online search of the databases CINAHL, Medline, Scopus, ABI, Academic Search Complete, HEALTHstar, ERIC, Psychinfo, and Embase, and a manual search of Emerald and Longwoods was conducted. (Quasi-) experimental studies with pre/post measures of interventions aimed at improving the NWE, study populations of nurses, and quantitative outcome measures of the nursing work environment were required for inclusion. Each study was assessed for methodological strength using a quality assessment and validity tool for intervention studies. A taxonomy of NWE characteristics was developed that would allow us to identify on which part of the NWE an intervention targeted for improvement, after which the effects of the interventions were examined. Results Over 9,000 titles and abstracts were screened. Eleven controlled intervention studies met the inclusion criteria, of which eight used a quasi-experimental design and three an experimental design. In total, nine different interventions were reported in the included studies. The most effective interventions at improving the NWE were: primary nursing (two studies), the educational toolbox (one study), the individualized care and clinical supervision (one study), and the violence prevention intervention (one study). Conclusions Little is known about the effectiveness of interventions aimed at improving the NWE, and published studies on this topic show weaknesses in their design. To advance the field, we recommend that
Background In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents’ behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. Methods/Design The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. Discussion The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents’ outcome measurements, making it possible to evaluate different aspects and concepts of care. PMID:24237990
Glenwick, David S.; Slutzsky, Mitchel R.; Garfinkel, Eric
Describes an 11-week course given at a nursing home to nursing home aides that focused on abnormal psychology and behavior intervention skills. Discusses the course goals, class composition, and course description. Addresses the problems and issues encountered with teaching this course to a nontraditional population in an unconventional setting.…
Wolfe, Linda C.
This paper presents findings from a quantitative, correlational study that examined selected school nursing services, student academic outcomes, and school demographics. Ex post facto data from the 2011-2012 school year of Delaware public schools were used in the research. The selected variables were school nurse interventions provided to students…
Meeks, Suzanne; Looney, Stephen W.; Van Haitsma, Kimberly; Teri, Linda
Purpose: This article (a) describes a 10-week, behavioral, activities-based intervention for depression that can be implemented in nursing homes collaboratively with nursing home activities staff and (b) presents data related to its development, feasibility, and preliminary outcomes. Design and Methods: We developed BE-ACTIV, which stands for…
Kok, Gerjo; Schaalma, Herman; Ruiter, Robert A C; van Empelen, Pepijn; Brug, Johannes
Evidence-based health promotion programmes are based on empirical data and theory. While a broad range of social and behavioural science theories are available, the actual application of these theories in programme design remains a real challenge for health promotion planners. Intervention Mapping describes a protocol for the development of theory- and evidence-based health promotion programmes. It provides guidelines and tools for the selection of theoretical foundations and underpinnings of health promotion programmes, for the application of theory, and for the translation of theory in actual programme materials and activities. This article presents the protocol and elaborates on the application of theory, using examples from successful intervention programmes.
Hamilton, Greg; O'Connell, Meghan; Cross, Donna
The purpose of this study was to examine the feasibility of a range of strategies to engage and to enhance secondary school nurse involvement in teenage smoking prevention and cessation. School nurses were willing to assist students to quit smoking, but they felt unprepared. Information provided by nurses involved in a three-stage review,…
Peres, Heloisa Helena Ciqueto; de Almeida Lopes Monteiro da Cruz, Diná; Lima, Antônio Fernandes Costa; Gaidzinski, Raquel Rapone; Ortiz, Diley Cardoso Franco; Mendes e Trindade, Michelle; Tsukamoto, Rosangela; Batista de Oliveira, Neurilene
Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.
Button, P S; Androwich, I; Mead, C N; Zingo, C; Konicek, D; Campbell, K E
The purpose of this paper is to report the work of the Interventions Group of the first Nursing Terminology Summit (1999) and to describe the challenges and insights of this group as they have evolved a reference terminology model for nursing interventions. When the group began its work as part of the first meeting of the Nursing Terminology Summit, it had the overall objective of proposing the intervention component of a reference terminology model for nursing. Although there is not a definitive proposal for this to date, the group's exploration and analysis has clarified and explicated both the types of models of clinical information and the current " state of the art" of formal representations of nursing interventions as well as the relationship of nursing languages to these formal representations. In addition, it is our perspective that the work of this group is representative of the process and challenges facing many similar groups currently engaged in modeling efforts. Consequently, critical success factors of such efforts are identified and discussed. This paper reports both the specific outputs of the group related to progress in defining a terminology model of nursing interventions and observations and lessons learned regarding consensus modeling work.
Kollee, I; Pearson, E
The goal of our dynamic progressive care unit patient education program was to empower hemodialysis patients to learn to be as independent in their hemodialysis treatments as their condition permitted, whether in the home or in the clinical setting. The paradigm shift that has placed patient education at the centre of health care has necessitated a practice change for both patients and nurses. In response to this change and to assist us to achieve our goal, a set of 14 hemodialysis teaching protocols has been developed. Individual protocols address specific aspects of the management of hemodialysis treatments and implementation, and are based upon the nursing process. Each protocol has an accompanying documentation and evaluation tool and can be used as an indicator for continuous quality improvement. Our success to date is evident in the placement of patients along the continuum of limited self-care starting in the progressive care unit and continuing to achieve increased independence by dialyzing in their own homes as part of the home hemodialysis program.
Aish, A E; Isenberg, M
The purpose of the study was to investigate the effect of nursing care based on Orem's nursing theory on nutritional self-care of myocardial infarction patients. Self-efficacy was explored as a disposition which may motivate behavioral change. One hundred and four subjects were randomly assigned to treatment or control groups. The nursing intervention, which took place during the first 6 weeks following hospital discharge, was effective in supporting healthy low-fat eating behavior. Nursing care influenced patients' self-care agency but lacked impact on self-efficacy for healthy eating. PMID:8736471
Aish, A E; Isenberg, M
The purpose of the study was to investigate the effect of nursing care based on Orem's nursing theory on nutritional self-care of myocardial infarction patients. Self-efficacy was explored as a disposition which may motivate behavioral change. One hundred and four subjects were randomly assigned to treatment or control groups. The nursing intervention, which took place during the first 6 weeks following hospital discharge, was effective in supporting healthy low-fat eating behavior. Nursing care influenced patients' self-care agency but lacked impact on self-efficacy for healthy eating.
Nejati, Adeleh; Shepley, Mardelle; Rodiek, Susan
The nursing profession in the United States is on the precipice of a crisis. Nurses are essential to the health care industry, and maintaining quality nursing care is a primary concern of today's health care managers. Health care facilities report high rates of staff burnout and turnover, and interest in the nursing profession among younger students is declining. Health care leaders must improve nurses' job satisfaction, performance, and retention. However, they often overlook the need for nurses' respite and underestimate the value of well-designed staff break areas. An exhaustive and systematic literature search was conducted in the summer of 2014, and all studies found on the topic were reviewed for their relevance and quality of evidence. The existing literature about the main causes of nurses' fatigue, barriers that prevent nurses from taking restorative breaks, and consequences of nurses' fatigue for staff, patient, and facility outcomes demonstrates the pressing need for interventions that improve nurses' working conditions. Additional literature on the restorative effects of breaks and the value of well-designed break areas indicates that efforts to improve breakroom design can play an important role in improving nurses' job satisfaction and performance. PMID:26814229
Nowrouzi, Behdin; Lightfoot, Nancy; Larivière, Michael; Carter, Lorraine; Rukholm, Ellen; Schinke, Robert; Belanger-Gardner, Diane
This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses' quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses' QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care. PMID:26084675
Casserly, Brian; Baram, Michael; Walsh, Patricia; Sucov, Andrew; Ward, Nicholas S; Levy, Mitchell M
The objective of this prospective cohort study was to see the effect of the implementation of a Sepsis Intervention Program on the standard processes of patient care using a collaborative approach between the Emergency Department (ED) and Medical Intensive Care Unit (MICU). This was performed in a large urban tertiary-care hospital, with no previous experience utilizing a specific intervention program as routine care for septic shock and which has services and resources commonly available in most hospitals. The study included 106 patients who presented to the ED with severe sepsis or septic shock. Eighty-seven of those patients met the inclusion criteria for complete data analysis. The ED and MICU staff underwent a 3-month training period followed by implementation of a protocol for sepsis intervention program over 6 months. In the first 6 months of the program's implementation, 106 patients were admitted to the ED with severe sepsis and septic shock. During this time, the ED attempted to initiate the sepsis intervention protocol in 76% of the 87 septic patients who met the inclusion criteria. This was assessed by documentation of a central venous catheter insertion for continuous SvO(2) monitoring in a patient with sepsis or septic shock. However, only 48% of the eligible patients completed the early goal-directed therapy (EGDT) protocol. Our data showed that the in-hospital mortality rate was 30.5% for the 87 septic shock patients with a mean APACHE II score of 29. This was very similar to a landmark study of EGDT (30.5% mortality with mean APACHE II of 21.5). Data collected on processes of care showed improvements in time to fluid administration, central venous access insertion, antibiotic administration, vasopressor administration, and time to MICU transfer from ED arrival in our patients enrolled in the protocol versus those who were not. Further review of our performance data showed that processes of care improved steadily the longer the protocol was in
Kaewboonchoo, Orawan; Ratanasiripong, Nop; Hanklang, Suda; Chumchai, Pornlert
Globally, graduate students have been found to have high prevalence of mental health problems. With increasing severity of mental health problems on university campuses and limited resources for mental health treatment, alternative interventions are needed. This study investigated the use of biofeedback training to help reduce symptoms of stress, anxiety, and depression. A sample of 60 graduate students in public health nursing was randomly assigned to either the biofeedback intervention or the control group. Results indicated that biofeedback intervention was effective in significantly reducing the levels of stress, anxiety, and depression over the 4-week period, while the control group had increases in symptoms of anxiety and depression over the same timeframe. As future leaders in the public health nursing arena, the more psychologically healthy the graduate students in public health nursing are, the better the public health nursing professionals they will be as they go forth to serve the community after graduation. PMID:25954515
Ratanasiripong, Paul; Kaewboonchoo, Orawan; Ratanasiripong, Nop; Hanklang, Suda; Chumchai, Pornlert
Globally, graduate students have been found to have high prevalence of mental health problems. With increasing severity of mental health problems on university campuses and limited resources for mental health treatment, alternative interventions are needed. This study investigated the use of biofeedback training to help reduce symptoms of stress, anxiety, and depression. A sample of 60 graduate students in public health nursing was randomly assigned to either the biofeedback intervention or the control group. Results indicated that biofeedback intervention was effective in significantly reducing the levels of stress, anxiety, and depression over the 4-week period, while the control group had increases in symptoms of anxiety and depression over the same timeframe. As future leaders in the public health nursing arena, the more psychologically healthy the graduate students in public health nursing are, the better the public health nursing professionals they will be as they go forth to serve the community after graduation. PMID:25954515
Griffin, Martha; Clark, Cynthia M
Ten years ago, Griffin wrote an article on the use of cognitive rehearsal as a shield for lateral violence. Since then, cognitive rehearsal has been used successfully in several studies as an evidence-based strategy to address uncivil and bullying behaviors in nursing. In the original study, 26 newly licensed nurses learned about lateral violence and used cognitive rehearsal techniques as an intervention for nurse-to-nurse incivility. The newly licensed nurses described using the rehearsed strategies as difficult, yet successful in reducing or eliminating incivility and lateral violence. This article updates the literature on cognitive rehearsal and reviews the use of cognitive rehearsal as an evidence-based strategy to address incivility and bullvina behaviors in nursing. PMID:25406637
Oncology nurses may experience intense physical and emotional exhaustion, identified in the literature as symptoms of cumulative grief and compassion fatigue, with significant consequences for both nurses and organizations. The first step in preventing these consequences is recognition. Organizations should provide nurses with resources including education, counseling, and opportunities to grieve. Nurses need to learn the importance of work-life balance, self-care strategies, and communication skills. Using recommendations from the literature, an educational intervention was designed with the purpose of providing nurses with knowledge, skills, and resources to practice effective self-care and recognize when assistance is needed. The program's objective was to help nurses develop the coping skills and inner resources necessary to maintain their emotional and physical health. PMID:25095300
Pbert, Lori; Druker, Susan; Gapinski, Mary A.; Gellar, Lauren; Magner, Robert; Reed, George; Schneider, Kristin; Osganian, Stavroula
Background: Models are needed for implementing weight management interventions for adolescents through readily accessible venues. This study evaluated the feasibility and ef?cacy of a school nurse-delivered intervention in improving diet and activity and reducing body mass index (BMI) among overweight and obese adolescents. Methods: Six high…
Gellar, Lauren; Druker, Sue; Osganian, Stavroula K.; Gapinski, Mary Ann; LaPelle, Nancy; Pbert, Lori
Objective: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. Setting and Participants: Fifteen focus groups at participating schools. One hundred subjects,…
Bradford, Althea Betty
A short-term intervention on participants' knowledge of cultural competence was provided to 38 students in a baccalaureate nursing program at Winston-Salem State University (WSSU). The study examined the effectiveness of this intervention. Although WSSU is a Historically Black University, the majority of students in this program were White.…
Caine, Vera; Mill, Judy; O'Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean
We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019
Renouf, Sarah; Bradbury, Katherine; Yardley, Lucy; Little, Paul
This qualitative study explored patients' experiences of nurse support for an Internet-delivered weight management intervention. Eighteen patients who had received either basic or regular nurse support (three or seven contacts, respectively) for the Internet intervention were interviewed. The data were analysed using thematic analysis. The findings suggest that more regular support for Internet interventions may have the potential to inhibit the development of autonomous motivation for weight loss, which might lead to problems in sustaining losses after support ends. Further research is now needed to confirm whether motivation is influenced by frequency of nurse support in Internet interventions in order to inform the development of optimal support which promotes sustained weight loss. PMID:25438990
Caine, Vera; Mill, Judy; O’Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean
We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019
Reichert, Altamira Pereira da Silva; Collet, Neusa; Eickmann, Sophie Helena; Lima, Marília de Carvalho
Objective: to evaluate the effectiveness of an educational action in child development surveillance performed by nurses working in primary health care. Methods: interventional study with a before-and-after type of design, carried out with 45 nurses and 450 mothers of children under 2 years of age. Initially, it was evaluated the practices and knowledge of nurses on child development surveillance and the mothers were interviewed about these practices. Subsequently, workshops were carried out with nurses and four months later, the knowledge of nurses and the maternal information were reevaluated. Results: after intervention there was significant increase in the frequency of the following aspects: from 73% to 100%, in relation to the practice of nurses of asking the opinion of mothers about their children's development; from 42% to 91%, regarding the use of the systematized instrument of evaluation; from 91% to 100% with respect to guidance to mothers on how to stimulate child development. Conclusions: the intervention contributed to the increase of knowledge of nurses and implementation of child development surveillance, showing the importance of this initiative to improve the quality of child health care. PMID:26487147
Maas, Edwin; Gildersleeve-Neumann, Christina; Jakielski, Kathy J.; Stoeckel, Ruth
This paper reviews current trends in treatment for childhood apraxia of speech (CAS), with a particular emphasis on motor-based intervention protocols. The paper first briefly discusses how CAS fits into the typology of speech sound disorders, followed by a discussion of the potential relevance of principles derived from the motor learning literature for CAS treatment. Next, different motor-based treatment protocols are reviewed, along with their evidence base. The paper concludes with a summary and discussion of future research needs. PMID:25313348
Background Malnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions. The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition. Methods/Design Intervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0–6–12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin. Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient’s nutritional status using the MNA test, diet, anthropometry, and biochemical parameters. Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention. The SPSS/PC program will be used for statistical analysis. Discussion The nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet
Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817
Goldfarb, Stanley; McCullough, Peter A.; McDermott, John; Gay, Spencer B.
Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. The panel reviewed materials retrieved by a PubMed search covering the period January 1990 through January 2008 and used combinations of key words associated with the prevention and treatment of contrast-induced AKI. In addition, the panel reviewed the reference lists of selected articles and the tables of contents posted on the Web sites of selected journals for relevant publications not retrieved in the PubMed searches. PMID:19181651
Napoleão, Anamaria Alves; Chianca, Tânia Couto Machado; de Carvalho, Emília Campos; Dalri, Maria Célia Barcellos
This study aimed at reviewing the knowledge produced about the Nursing Interventions Classification (NIC) available in the scientific literature from January 1980 to January 2004. NIC is a taxonomy with activities performed by nurses. Authors searched Lilacs and Medline databases, materials at the Center for Nursing Classification-University of Iowa College of Nursing and a doctoral dissertation obtained from a private library. The works found referred to the application of NIC to practice, the languages used in information systems, the use of NIC in these systems and the presentation, construction, development and validation of a taxonomy, among others. Authors concluded that there are several possibilities related to the production of knowledge on NIC in Brazil and that it is necessary to encourage studies on this taxonomy, raising questions and generating new knowledge to contribute to the improvement of Brazilian Nursing.
Scain, Suzana Fiore; Franzen, Elenara; dos Santos, Luciana Batista; Heldt, Elizeth
The objective of this study was to identify the accuracy of nursing interventions from the nursing diagnoses (ND) of patients who consulted in the Program for Diabetes Education, in outpatient care of the university hospital relating them with sociodemographic characteristics and comorbidities. It was a cross-sectional study of 136 patients with type 2 diabetes mellitus (DM2), with 77 (57%) women, with an average age of 66 +/- 9.38 years, and the presence of comorbidities in 97 (71%), and using medications. A significant association was found between the NDs and the most frequently prescribed interventions. "nutritional counseling" (n=99; 73%), "promotion of exercise" (n=64; 47%) and "teaching: feet care (n=48; 35%); however, not with the sociodemographic characteristics or comorbidities. The interventions most prescribed in nursing consultations showed ND accuracy for the domains of Promotion of Health and Nutrition, which are related to the principles of treatment for DM2: healthy eating, physical exercise and health education.
Song, Misoon; Choi, Suyoung; Kim, Se-An; Seo, Kyoungsan; Lee, Soo Jin
Development of behavior theory-based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome-focused health education programs.
Song, Misoon; Choi, Suyoung; Kim, Se-An; Seo, Kyoungsan; Lee, Soo Jin
Development of behavior theory-based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome-focused health education programs. PMID:26062288
Schoberer, Daniela; Leino-Kilpi, Helena; Breimaier, Helga E; Halfens, Ruud JG; Lohrmann, Christa
Purpose of the study Health education is essential to improve health care behavior and self-management. However, educating frail, older nursing home residents about their health is challenging. Focusing on empowerment may be the key to educating nursing home residents effectively. This paper examines educational interventions that can be used to empower nursing home residents. Methods A systematic literature search was performed of the databases PubMed, CINAHL, CENTRAL, PsycINFO, and Embase, screening for clinical trials that dealt with resident education and outcomes in terms of their ability to empower residents. An additional, manual search of the reference lists and searches with SIGLE and Google Scholar were conducted to identify gray literature. Two authors independently appraised the quality of the studies found and assigned levels to the evidence reported. The results of the studies were grouped according to their main empowering outcomes and described narratively. Results Out of 427 identified articles, ten intervention studies that addressed the research question were identified. The main educational interventions used were group education sessions, motivational and encouragement strategies, goal setting with residents, and the development of plans to meet defined goals. Significant effects on self-efficacy and self-care behavior were reported as a result of the interventions, which included group education and individual counseling based on resident needs and preferences. In addition, self-care behavior was observed to significantly increase in response to function-focused care and reasoning exercises. Perceptions and expectations were not improved by using educational interventions with older nursing home residents. Conclusion Individually tailored, interactive, continuously applied, and structured educational strategies, including motivational and encouraging techniques, are promising interventions that can help nursing home residents become more
Rouleau, Geneviève; Ramirez-Garcia, Pilar; Bourbonnais, Anne
Background Persons living with HIV (PLHIV) must adhere optimally to antiretroviral therapy (ART) on a daily basis and for their lifetime to maintain an undetectable viral load, allowing them to preserve their health. Taking advantage of the opportunity that information and communication technologies provide to broaden intervention modalities and intensify clinical follow-up, a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. Compared with other types of information and communication technologies-assisted interventions such as text messages, HIV Treatment, Virtual Nursing Assistance and Education (VIH-TAVIE) requires a certain degree of active engagement on the part of the user to develop and strengthen the self-management skills to optimize adherence. After the intervention’s impact on ART adherence was measured quantitatively, a qualitative study was undertaken to describe how users experience the intervention. Understanding how PLHIV perceive being assisted asynchronously by a virtual nurse was of particular interest. Objective The objective of the study was to explore and describe how PLHIV experience VIH-TAVIE, that is, receiving customized asynchronous accompaniment via a virtual nurse. Methods A qualitative study was conducted with 26 PLHIV (20 men, 6 women) who received all four VIH-TAVIE sessions. Participants had been diagnosed with HIV 14 years earlier on average and had been on ART for a mean period of 10 years. The sessions lasted 20-30 minutes each and were received two weeks apart. They are hosted by a virtual nurse who engages the user in a self-management skills-learning process for the purpose of treatment adherence. Semistructured interviews were conducted lasting 30-40 minutes to get participants to share their experience of the intervention through personal stories and what they thought and felt during their participation. Data were analyzed
De Craemer, M; De Decker, E; De Bourdeaudhuij, I; Verloigne, M; Duvinage, K; Koletzko, B; Ibrügger, S; Kreichauf, S; Grammatikaki, E; Moreno, L; Iotova, V; Socha, P; Szott, K; Manios, Y; Cardon, G
Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers.
Williams, Kristine; Kemper, Susan; Hummert, Mary Lee
Evaluates a brief educational program designed to increase staff awareness of intergenerational speech modifications, such as elderspeak and strategies to enhance communication. After the training, Certified Nursing Assistants reduced their use of elderspeak including terms of endearment, inappropriate collective pronouns, and shortened sentence…
Ceballos, Kirtley; Waterman, Kari; Hulett, Teresa; Makic, Mary Beth Flynn
Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units. Central line-associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) are costly, preventable infections targeted for eradication by the Centers for Disease Control and Prevention. After evaluation of current practice and areas for improvement, neonatal-specific CLABSI and VAP bundles were developed and implemented on the basis of available best evidence. The overall goal was to reduce infection rates at or below benchmarks set by National Healthcare Safety Network. All neonates with central lines (umbilical or percutaneous) and/or patients who were endotracheally intubated were included. All patients were risk stratified on the basis of weight per National Healthcare Safety Network reporting requirements: less than 750 g, 751-1000 g, 1001-1500 g, 1501-2500 g, and greater than 2500 g. The research was conducted as a quality improvement study. Neonatal-specific educational modules were developed by neonatal nurse leaders for CLABSI and VAP. Bundle development entailed combining select interventions, mainly from the adult literature, that the nurse leaders believed would reduce infection rates. Nursing practice guidelines and supply carts were updated to ensure understanding, compliance, and convenience. A CLABSI checklist was initiated and used at the time of line insertion by the nurse to ensure standardized infection control practices. Compliance audits were performed by nurse leaders weekly on intubated patients to validate VAP bundle implementation. CLABSI and VAP bundle compliance was audited and infection rates were measured before and after both bundle implementations following strict National Healthcare Safety Network inclusion criteria for CLABSI and VAP determination. The reduction in CLABSI elicited 84 fewer hospital days, estimated cost savings of $348,000, a 92% reduction in CLABSI (preintervention to postintervention
Ekti Genc, Rabia; Conk, Zeynep
This experimental, randomized controlled study was conducted for children with cancer who are 7 to 12 years of age and receiving chemotherapy treatment to detect the impact of appropriate nursing interventions on decreasing the fatigue syndrome. The research sample is composed of a total of 60 children with cancer, with 30 children being included in the experimental group and 30 children included in the control group with their mothers. In the experimental group, after the 7th to 10th day of the chemotherapy treatment, throughout a week, the researcher conducted the effective nursing interventions every day for 45 to 60 minutes. In the control group, routine nursing interventions were carried out. The experimental and control group children's mean scores for the Fatigue Scale-Child and those of mothers for Fatigue Scale-Parent were compared. A statistically significant difference was found between the Fatigue Scale-Child and Fatigue Scale-Parent mean scores of the experimental and the control group children (P < .00). These results suggest that fatigue of children with cancer can be reduced by implementing appropriate nursing interventions. PMID:18600119
dos Santos, Daniella Soares; de Carvalho, Emília Campos
This integrative review aimed to analyze the scientific literature related to nursing care for patients with arthritis. Twelve experimental studies were included, randomized and controlled, published in CINAHL, MEDLINE, SciELO and LILACS databases, using the controlled keywords "arthritis" and "nursing". The results indicated the effectiveness of music therapy, neuromuscular electrical stimulation, therapeutic touch and guided imagery associated with relaxation, for the treatment of pain. Being treated by a specialist nurse increased satisfaction with care, improved the impact of the disease and increased the demand for health services. Specific educational programs for people with arthritis stimulated the practice of physical exercises and those targeted to people with chronic conditions in general were effective to control pain and functional disability. We conclude that there is a set of interventions that can support the practice of evidence-based nursing for the elderly people with arthritis. PMID:23559181
Puntil, Cheryl; York, Janet; Limandri, Barbara; Greene, Pamela; Arauz, Eric; Hobbs, Deborah
Suicide is the tenth leading cause of death in the United States. Approximately 90,000 psychiatric mental health (PMH) nurse generalists work in hospitals in the United States, mostly on inpatient psychiatric units where the most acutely suicidal patients are hospitalized. Although competencies have been developed for mental health clinicians in assessing and managing suicide risk, there are no standard competencies for PMH nurse generalists. Widely accepted nursing practices do not meet suicide-specific standards of care or evidence-based criteria. Although both the Commission on Collegiate Nursing Education Essentials for Baccalaureate Education and the Quality and Safety Education for Nurses competencies stress the necessity for comprehensive assessment, safe clinical practices, patient-centered care, evidence-based interventions, and interprofessional communication and collaboration, there are no specific requirements for suicide prevention training in educational and clinical programs. The American Psychiatric Nurses Association has an opportunity to provide leadership in developing, implementing, and evaluating competency-based training for nurses and partner with the national effort to increase the competencies in suicide prevention in the behavioral health workforce. PMID:23950543
Puntil, Cheryl; York, Janet; Limandri, Barbara; Greene, Pamela; Arauz, Eric; Hobbs, Deborah
Suicide is the tenth leading cause of death in the United States. Approximately 90,000 psychiatric mental health (PMH) nurse generalists work in hospitals in the United States, mostly on inpatient psychiatric units where the most acutely suicidal patients are hospitalized. Although competencies have been developed for mental health clinicians in assessing and managing suicide risk, there are no standard competencies for PMH nurse generalists. Widely accepted nursing practices do not meet suicide-specific standards of care or evidence-based criteria. Although both the Commission on Collegiate Nursing Education Essentials for Baccalaureate Education and the Quality and Safety Education for Nurses competencies stress the necessity for comprehensive assessment, safe clinical practices, patient-centered care, evidence-based interventions, and interprofessional communication and collaboration, there are no specific requirements for suicide prevention training in educational and clinical programs. The American Psychiatric Nurses Association has an opportunity to provide leadership in developing, implementing, and evaluating competency-based training for nurses and partner with the national effort to increase the competencies in suicide prevention in the behavioral health workforce.
Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill
Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681
Silva, Kenya de Lima; Évora, Yolanda Dora Martinez; Cintra, Camila Santana Justo
Objective: to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba. Method: a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development. Result: the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan. Conclusion: the development of this tool used to document the nursing actions will contribute to decision-making and quality of care. PMID:26487144
Background Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours. Methods/Design Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. Discussion With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership
Parker, Karen M; Harrington, Ann; Smith, Charlene M; Sellers, Kathleen F; Millenbach, Linda
Horizontal violence (HV) is prevalent in nursing. However, few strategies are identified to address this phenomenon that undermines communication and patient safety. Nurses at an acute care hospital implemented multiple interventions to address HV resulting in increased knowledge of hospital policies regarding HV, and significantly (p < .05) less HV prevalence than was reported by nurses in other organizations throughout New York State. With the aid and oversight of nursing professional development specialists, evidence-based interventions to address HV were developed including policies, behavioral performance reviews, and staff/manager educational programs. PMID:26985749
Kindblom-Rising, Kristina; Wahlstrom, Rolf; Ekman, Sirkka-Liisa; Buer, Nina; Nilsson-Wikmar, Lena
The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. STATEMENT OF RELEVANCE: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.
Breimaier, Helga E.; Halfens, Ruud J. G.; Wilborn, Doris; Meesterberends, Esther; Haase Nielsen, Gunnar
Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework. PMID:23956875
LaFond, Cynthia M.; Vincent, Catherine Van Hulle; Corte, Colleen; Hershberger, Patricia E.; Johnson, Andrew; Park, Chang G.; Wilkie, Diana J.
The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses’ pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present. PMID:25682019
Molloy, Margory A; Sabol, Valerie K; Silva, Susan G; Guimond, Mary Elizabeth
Nurse educators are uniquely positioned to improve obesity-related attitudes and beliefs among prelicensure nursing students. A bariatric sensitivity intervention using 6 trigger films with facilitated debriefing was designed and delivered to 70 first-semester baccalaureate nursing students. Attitudes and beliefs significantly improved immediately after the intervention on 3 of the 5 attitude measures and on the belief measure. Improvements in beliefs/attitudes were sustained 30 days after the intervention but may require content reinforcement throughout the curriculum for long-term effects. PMID:26448157
Faraklas, Iris; Holt, Brennen; Tran, Sally; Lin, Hsin; Saffle, Jeffrey; Cochran, Amalia
The purpose of this study was to evaluate the impact on sleep quality of a nursing-driven sleep hygiene protocol (SHP) instituted in a single burn-trauma intensive care unit. Criteria for eligibility were adult patients admitted to the Burn Service who were not delirious, able to respond verbally, and had not received general anesthesia in the prior 24 hours. Patients were surveyed using the validated Richards-Campbell Sleep Questionnaire prior to implementation ("PRE"; May to December 2010) and following implementation ("POST"; January to August 2011) of a SHP that sought to minimize environmental stimuli and limit disruptions during the night. This analysis includes only initial survey responses from each patient. A total of 130 patients were surveyed, 81 PRE and 49 POST; 60% were burn admissions. There was no significant difference in responses to the questionnaire between burn and nonburn patients. All patients in the POST group were significantly older and more frequently endorsed taking sleep medication at home. Although not significant, POST patients reported falling asleep somewhat more quickly, but no other differences were identified between the two groups. Among patients who reported having sleep difficulties prior to admission, POST patients not only reported a significantly higher pain score than PRE patients, but also reported significant improvement in falling asleep and being able to go back to sleep. Frequency of complaints of sleep disruption was unchanged between PRE and POST patients. POST patients did complain significantly less than PRE patients about sleep disruptions by clinicians. Implementation of the SHP permitted acutely injured or ill patients in our intensive care unit to fall asleep more quickly and to experience fewer sleep disruptions. A sleep protocol may be helpful in improving sleep and overall well-being of burn center patients. PMID:23412331
Tenkanen, Helena; Tiihonen, Jari; Repo-Tiihonen, Eila; Kinnunen, Juha
The importance of core competencies (CC) and their relationship to core interventions in clinical practice guidelines on schizophrenia (CPGS), and the abilities to master these competencies were studied among registered nurses (RN) and practical mental nurses (PMN) in a forensic psychiatric setting. Data were collected from RNs, PMNs, and managers of all five forensic psychiatric facilities in Finland. The research material was obtained by using a 360-degree feedback method. The response rate was 68% (N = 428). The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the importance of and ability to master the following CCs: (1) pharmacotherapy, (2) knowledge in forensic psychiatry and violent behavior, (3) the treatment of violent patients, (4) processing patient's and own emotion, and (5) need-adapted treatment of the patient. Overall, RNs exceeded PMNs in mastering the CCs, however the principles of the CPGS were not achieved within the current resources in Finland. In summary, RNs, rather than PMNs, should be recruited for work in forensic psychiatric nursing, although a considerable amount of specific training would still be required to achieve competence. Implications of our research indicate that all nurses working in this area need to receive further education in forensic psychiatry and in forensic psychiatric nursing.
Ratanasiripong, Paul; Ratanasiripong, Nop; Kathalae, Duangrat
Purpose. It has been well documented that nursing students across the world experience stress and anxiety throughout their education and training. The purpose of this randomized controlled study is to investigate the impact of biofeedback intervention program on nursing students' levels of stress and anxiety during their first clinical training. Methods. Participants consisted of 60 second-year baccalaureate nursing students. The 30 participants in the biofeedback group received training on how to use the biofeedback device to assist in stress and anxiety management for 5 weeks while the 30 in the control group did not receive any training. Findings. Results indicated that the biofeedback group was able to maintain the stress level while the control group had a significant increase in the stress level over the 5-week period of clinical training. Additionally, the biofeedback group had a significant reduction in anxiety, while the control group had a moderate increase in anxiety. Conclusions. The better the nursing students can manage their stress and anxiety, the more successful they can be in their clinical training. Ultimately, the more psychologically healthy the nursing students are, the more likely they will flourish and graduate to become productive and contributing members of the nursing profession. PMID:22811932
Spirig, Rebecca; Spichiger, Elisabeth; Martin, Jacqueline S.; Frei, Irena Anna; Müller, Marianne; Kleinknecht, Michael
Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. Background: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. Methods/Design: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting
Hewitt, Jayne; Tower, Marion; Latimer, Sharon
Medication safety is a significant issue. Whilst medication administration is a routine task, it is a complex nursing activity. It is recognised in the literature that medication related adverse events are most often related to systems failures associated with the complex process of medication administration. This paper examines student's perceived effectiveness of an educational intervention, designed to demonstrate the complex and multidisciplinary factors of systems related failures in medication administration. The intervention was underpinned by adult and experiential learning concepts and used a problem-based learning approach. A series of short digital recordings were developed along with discussion points to illustrate multidisciplinary interactions involved in medication administration. A small sample of second and third year undergraduate nursing students (n = 28) evaluated the effectiveness of the educational resource. Our findings suggest that such resources are effective in demonstrating the complexity of medication related error and were authentic to practice. An educational intervention using problem based learning afforded nursing students the opportunity to engage with the systems factors that contribute to medication errors. Interventions that highlight these factors may play an important role in raising awareness of these issues and encourage students to carry this knowledge into clinical practice.
Karpavičiūtė, Simona; Macijauskienė, Jūratė
Over 59 million workers are employed in the healthcare sector globally, with a daily risk of being exposed to a complex variety of health and safety hazards. The purpose of this study was to investigate the impact of arts activity on the well-being of nursing staff. During October-December 2014, 115 nursing staff working in a hospital, took part in this study, which lasted for 10 weeks. The intervention group (n = 56) took part in silk painting activities once a week. Data was collected using socio-demographic questions, the Warwick-Edinburgh Mental Well-Being Scale, Short Form-36 Health Survey questionnaire, Reeder stress scale, and Multidimensional fatigue inventory (before and after art activities in both groups). Statistical data analysis included descriptive statistics (frequency, percentage, mean, standard deviation), non-parametric statistics analysis (Man Whitney U Test; Wilcoxon signed-ranks test), Fisher's exact test and reliability analysis (Cronbach's Alpha). The level of significance was set at p ≤ 0.05. In the intervention group, there was a tendency for participation in arts activity having a positive impact on their general health and mental well-being, reducing stress and fatigue, awaking creativity and increasing a sense of community at work. The control group did not show any improvements. Of the intervention group 93% reported enjoyment, with 75% aspiring to continue arts activity in the future. This research suggests that arts activity, as a workplace intervention, can be used to promote nursing staff well-being at work. PMID:27104550
Young, Heather; Ward, Deborah; Dharmar, Madan; Tang-Feldman, Yajarayma; Berglund, Lars
Abstract Background: Diabetes educators and self-management programs are scarce in rural communities, where diabetes is the third highest-ranking health concern. The goal of this study was to evaluate the benefits of nurse telehealth coaching for persons with diabetes living in rural communities through a person-centered approach using motivational interviewing (MI) techniques. Materials and Methods: A randomized experimental study design was used to assign participants to receive either nurse telehealth coaching for five sessions (intervention group) or usual care (control group). Outcomes were measured in both groups using the Diabetes Empowerment Scale (DES), SF-12, and satisfaction surveys. Mean scores for each outcome were compared at baseline and at the 9-month follow-up for both groups using a Student's t test. We also evaluated the change from baseline by estimating the difference in differences (pre- and postintervention) using regression methods. Results: Among the 101 participants included in the analysis, 51 received nurse telehealth coaching, and 50 received usual care. We found significantly higher self-efficacy scores in the intervention group compared with the control group based on the DES at 9 months (4.03 versus 3.64, respectively; p<0.05) and the difference in difference estimation (0.42; p<0.05). Conclusions: The nurse MI/telehealth coaching model used in this study shows promise as an effective intervention for diabetes self-management in rural communities. The sustained effect on outcomes observed in the intervention group suggests that this model could be a feasible intervention for long-term behavioral change among persons living with chronic disease in rural communities. PMID:25061688
Hudson, D B; Elek, S M; Westfall, J R; Grabau, A; Fleck, M O
The purpose of this exploratory, descriptive pilot study was to describe the usage of the Young Parents Project, a computer network offering health information and support, to adolescent mothers. Nine midwestern adolescent mothers were provided a computer so they could access the Young Parents Project in their homes. Participants gained access to the computer network 834 times for a total of 7,046 minutes during the year of the study. Adolescent mothers read and posted 402 electronic messages to one another and 110 electronic mail messages to advanced practice nurses. The following eight themes emerged when participants' electronic messages were analyzed using content analysis: introductions, emotional support, social support systems, infant sharing, infant issues, postpartum issues, finances and education, and computer support. The adolescent mothers' evaluation of the Young Parents Project was primarily positive, and the project served as a mechanism for providing health information and social support to adolescent mothers.
Psoriasis is a chronic disease that affects more than the skin. It has an impact on every facet of an individual's life and is associated with numerous comorbidities, such as obesity, diabetes, cardiovascular disease, psoriatic arthritis, metabolic syndrome, squamous cell carcinoma, lymphoma, depression, anxiety and other immune-related conditions, such as Crohn's disease. Obesity is inextricably linked with type 2 diabetes, hypertension, hyperlipidemia, and cardiovascular disease. Hypertension and cardiovascular disease are precursors for myocardial infarction and stroke. Lifestyle choices, such as smoking, alcohol consumption, inadequate nutrition and physical exercise are behaviours that need to be addressed. With the right education from the community nurse, patients can be informed about the decisions they make and can ultimately choose to live a healthier life. PMID:24800325
Winston, P A; Morelli, P; Bramble, J; Friday, A; Sanders, J B
Nationally, much attention has been placed on the indiscriminate application and abuse of restraint usage. This was the impetus for health care institutions across the country to relook at the policy, practices, and procedures regarding restraints. Our health care system made changes to our restraint policy, practice guidelines, and procedures in an effort to assure protection of the patients' health and safety while preserving their dignity, rights, and well-being. The mission was to pursue a restraint-appropriate environment by restraining only those patients who were assessed as being at risk of harming self and to protect the patient or others from injury. Our overall goal was to reduce restraint usage. This article describes the current policies, practice guidelines, and procedures for identifying clinically appropriate and adequately justified situations for restraint usage. The focus is on implementation of nurse-driven restraint protocols to improve patient care. All efforts directed at improvements in restraint usage and management of a patient in restraints has reduced our overall numbers of patients in restraints as well as significantly reduced risk of incidence for patients in restraints. PMID:10476623
Background High levels of sedentary behavior are often measured in preschoolers, but only a few interventions have been developed to counteract this. Furthermore, detailed descriptions of interventions in preschoolers targeting different forms of sedentary behavior could not be located in the literature. The aim of the present paper was to describe the different steps of the Intervention Mapping Protocol used towards the development of an intervention component of the ToyBox-study focusing on decreasing preschoolers’ sedentary behavior. The ToyBox-study focuses on the prevention of overweight in 4- to 6-year-old children by implementing a multi-component kindergarten-based intervention with family involvement in six different European countries. Methods Applying the Intervention Mapping Protocol, six different steps were systematically completed for the structured planning and development of the intervention. A literature search and results from focus groups with parents/caregivers and kindergarten teachers were used as a guide during the development of the intervention and the intervention materials. Results The application of the different steps in the Intervention Mapping Protocol resulted in the creation of matrices of change objectives, followed by the selection of practical applications for five different intervention tools that could be used at the individual level of the preschool child, at the interpersonal level (i.e., parents/caregivers) and at the organizational level (i.e., kindergarten teachers). No cultural differences regarding preschoolers’ sedentary behavior were identified between the participating countries during the focus groups, so cultural and local adaptations of the intervention materials were not necessary to improve the adoption and implementation of the intervention. Conclusions A systematic and evidence-based approach was used for the development of this kindergarten-based family-involved intervention targeting preschoolers, with
Delk, Kayla L
This article explores general principles of workers' compensation law and the ability to sue third parties for employee injuries by using case law and the treatise Larson's Workers' Compensation Law. This overview provides occupational health nurses with a background on workers' compensation law, who is liable for employee injuries, and how recovery from third parties is distributed between the employer or insurer and the employee. The author then explores interventions that occupational health nurses can implement to reduce employee injury and employer costs for providing workers' compensation. The goal of this article is to stimulate occupational health nurses' critical-thinking and problem-solving skills so they may identify risks and implement cost-effective solutions that will prevent injuries to employees. PMID:22387245
Background Racial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol. Methods/design Using a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy). Discussion Using a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date. Trial registration ClinicalTrials.gov NCT01425515. PMID:24156629
Bélanger, Louise; Ducharme, Francine
Though delirium is a common complication among hospitalized older adults and the nursing care required in these situations is complex, the subject has received little attention in the literature on continuing nursing education. A study was undertaken to field test and qualitatively evaluate a narrative-based educational intervention for nurses in hospital units with a high incidence of delirium. Triangulated data collection allowed carrying out a qualitative evaluation of the intervention process and outcomes. Process evaluation showed that the intervention was facilitated by the participants' attitudes and diversity of experience, as well as by the use of real care situations, which allowed integrating theory and practice. Outcome evaluation brought to light numerous elements of empirical, ethical and esthetic knowledge expressed by the participants. Study results evidence the applicability of such interventions as part of continuing nursing education and their contribution to knowledge development.
Peery, Annette I.; Engelke, Martha Keehner; Swanson, Melvin S.
Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this…
Holmes, Douglas; Teresi, Jeanne A; Ramirez, Mildred; Ellis, Julie; Eimicke, Joseph; Jian Kong; Orzechowska, Lucja; Silver, Stephanie
This project assessed the extent to which modern technology (Vigil) can augment or substitute for direct staff intervention in nonacute late-evening and nighttime situations in a nursing home setting. Vigil was implemented for dementia residents of a special care unit (SCU) in a large nursing home. An SCU matched in terms of unit-wide case mix and cognition was used for comparison. Results showed that there was no significant reduction in falls and injuries, but there was a significant improvement in affective disorder in the intervention group as contrasted with the comparison group. There was no significant increase in staff-perceived burden, despite the significant increase in the amount of direct care time logged. Additional time spent in staff care was significantly related to decreased affective disorder. The findings related to Vigil are generally mixed. The question remains as to whether the improvement in affect was due to Vigil or vigilance.
Background There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF. Methods and design This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before–after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops. Discussion This review will provide
Morita, Tatsuya; Murata, Hisayuki; Hirai, Kei; Tamura, Keiko; Kataoka, Jun; Ohnishi, Hideki; Akizuki, Nobuya; Kurihara, Yukie; Akechi, Tatsuo; Uchitomi, Yosuke
Recent empirical studies revealed that fostering patients' perception of meaning in their life is an essential task for palliative care clinicians. However, few studies have reported the effects of training programs for nurses specifically aimed at improving skills to relieve the meaninglessness of terminally ill cancer patients, and we have had no specific measurement instruments. The primary aims of this study were 1) to validate measurement tools to quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness and 2) to explore the effects of the five-hour educational workshop focusing on meaninglessness on nurses' self-reported practice, attitudes toward caring for such patients, confidence, burnout, death anxiety, and meaning of life. A quasi-experimental pre-post questionnaire survey was performed on 147 nurses. The questionnaire was distributed before the intervention workshop and one and six months after. The workshop consisted of lecture, role-play, and the exercise of assessment and care planning based on two vignette verbatim records. First, using the first questionnaire sample and an additional sample of 20 nurses for the test-retest examination, we validated a six-item Self-Reported Practice scale, and an eight-item Attitudes Toward Caring for Patients Feeling Meaninglessness scale with three subscales (Willingness to Help, Positive Appraisal, and Helplessness). The nurses also completed a scale to assess confidence in caring for terminally ill patients with meaninglessness, the Maslach Burnout Inventory, the Death Attitude Inventory, the Frommelt Attitudes Toward Care of the Dying scale, the Self-Reported Practice Score in General Communication, and the three pain-related items from the Palliative Care Quiz for Nursing. For the Self-Reported Practice scale and the subscales of the Attitudes Toward Caring for Patients Feeling Meaninglessness scale, the Cronbach's alpha coefficients were 0
Hypertension in patients on hemodialysis (HD) contributes significantly to their morbidity and mortality. This study examined whether a supportive nursing intervention incorporating monitoring, goal setting, and reinforcement can improve blood pressure (BP) control in a chronic HD population. A randomized controlled design was used and 118 participants were recruited from six HD units in the Detroit metro area. The intervention consisted of (1) BP education sessions; (2) a 12-week intervention, including monitoring, goal setting, and reinforcement; and (3) a 30-day post-intervention follow-up period. Participants in the treatment were asked to monitor their BP, sodium, and fluid intake weekly for 12 weeks in weekly logs. BP, fluid and sodium logs were reviewed weekly with the researcher to determine if goals were met or not met. Reinforcement was given for goals met and problem solving offered when goals were not met. The control group received standard care. Both systolic and diastolic BPs were significantly decreased in the treatment group.
Heyman, Inga; Webster, Brian J; Tee, Stephen
Suicide remains a global public health issue and a major governmental concern. The World Health Organisation argues for continued investment in education for front-line professionals, with a particular focus on nurses, to address the rising suicide levels. Considering this rate, it could be argued that suicide has impacted on the lives of many, including the student nurse population. Understanding the psychological impact, and influence on learning, whilst developing suicide intervention knowledge is crucial. However, little is known of the student experience in this complex and challenging area of skills development. This phenomenographic study examines the experiences of second year Bachelor of Nursing (mental health) students who participated in the Applied Suicide Intervention Skills Training (ASIST). Experiences were illuminated through two focus groups, Experiences were distilled and categorised through hierarchically relationships to construct a group experiential field to illustrate understandings of the impact this approach has on learning Students found ASIST to be emotionally challenging yet an extremely positive experience through bonding, peer learning, and class cohesion. The supportive workshop facilitation was essential allowing for full immersion into role simulation thus developing student confidence. Appropriate pedagogy and student support must be considered whilst developing suicide intervention in the pre-registration curricula.
Miquel Capó Rn, I
The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn.
Maloy, Debra A.
Traditionally, nurse anesthesia educators have utilized prior academic achievement to predict student success. However, research has indicated that prior academic achievement offers an inadequate assessment of student success in graduate healthcare programs with extensive clinical residencies. The educational literature has identified many non-cognitive factors, such as self-efficacy and locus of control, that may provide a more holistic prediction model of student success. An experimental study with pretest-posttest design and stratified random assignment was conducted to evaluate the effectiveness of an educational intervention to promote self-management, professional socialization, and academic achievement among first semester graduate nurse anesthesia students. Participants (N = 66) were demographically similar to the national graduate nurse anesthesia student body, though Hispanics and younger students were a little over-represented in the sample (56% female, 75.8% White, 15.2% Hispanic, 6% Other, 59% ≤ 30-years-old, 67% ≤ 3 years of ICU). The results showed that most graduate anesthesia students had strong self-management and professional socialization characteristics on admission. The results did not support the effectiveness of this educational intervention. Thus, ceiling effect may have accounted in part for statistically non-significant results regarding self-efficacy (p = .190, o2 = .03), locus of control (p = .137, o2 = .04), professional socialization (p = .819, o2 = .001), and academic achievement (p = .689, o2 = .003). Future researchers may need to expand the scope of the intervention, use a more powerful and sensitive instrument, and utilize a larger sample.
Gümüs, Aysun Babacan; Cam, Olcay
The purpose was to examine the effect of emotional support-focused nursing interventions on the psychosocial adjustment of breast cancer patients. The research was conducted in the Radiation Oncology Department of Ege University Medical Faculty Hospital and at Talay Aktas Oncology Hospital in Turkey. There were 30 newly diagnosed breast cancer patients included in the sample. Emotional support-focused nursing interventions were administered in seven sessions individually with each patient. A total of 210 hours of meetings with the patients were conducted. Data were collected by administering a pre-test and post-test in two phases with the patients using a Descriptive Information Form and the Psychosocial Adjustment to Illness Scale - Self Report (PAIS-SR). The patients mean age was 44.5 (SD=6.38) years and the mean duration of illness was 6.46 (SD=1.99) months. In the comparison of the PAIS-SR pretest and post-test mean scores it was determined that there was a significant increase in patients adaptation to health care orientation (p=0.001), domestic environment (p<0.01), sexual relationships (p<0.05), extended family relationships (p<0.001) and social environment (p<0.001), and a significant decrease in psychological distress (p<0.001). However, there was no change in patients vocational adjustment (p<0.05). According to these findings emotional support-focused nursing interventions had a part in increasing patients psychosocial adjustment. PMID:19256761
There is no one formula for culcure change. A joint steering committee of staff members can develop plans that will build trust, address each other as equals, and drive out fear as they move the process of change. Training and sharing information help staff recognize this is a process, not an event. New well-screened team members need training to integrate them into the culture. It is important to identify the knowledge and expertise of team members to maximize their energies and talents. Recruitment and retention of those who share the values of this culture are of paramount importance. It is worth the time and effort to secure commitment to these values. One example of this effort is a facility in Pennsylvania that, at its worst, had two thirds of its staff turnover in a year. The national average was 82% in 1995, an increase from 71.5% the year before. They were able to reduce their turnover rate to 27% by examining the hiring records and finding that workers with certain personality traits and attitudes were less likely to leave. They looked for compassion and communication skills, perceptions of older adults, ability to cope with death and dying, and ability to handle the unpleasant tasks of residene hygiene and bathroom visits. Current staff members determined and voted on best fit of candidates (Montague, 1997). Although training and evaluation are an important component of retention and commitment to values in any organization, training and evaluation of nursing home employees may be quite different from other employment. A nurse in a nursing home needs to be evaluated not only on clinical skills, but on communication skills, attitude, and leadership (Meyer, 1995). Then training and employee development programs can be targeted to specific areas for corrective action. What is taught in training and what occurs on the job should correspond, or role conflict occurs increasing the likelihood of turnover (Steffen, Nystrom, O'Connor, 1996). Although occasional
Al-Hamad, Arif; Al-Ibrahim, Maha; Alhajhouj, Eman; Al-Alshaikh Jaffer, Waseelah; Altowaileb, Jaffar; Alfaraj, Hassan
Compared with truly negative cultures, false positive blood cultures (BCs) not only increase laboratory work but also prolong the lengths of patient stays, which are likely to increase patient morbidity and costs. The present study aimed to evaluate the effectiveness of a hospital-wide educational intervention on BC contamination rates. Nurses performed all phlebotomies; therefore, educational workshops were offered to all nurses twice a week over a 3-month period. The workshops consisted of a questionnaire, PowerPoint presentation, video show, demonstration of the different materials used to collect BCs, and question session. Data from the questionnaires and laboratory culture results were compared between the 6-month pre- and post-intervention periods. Of the 503 eligible nurses, 216 (42.9%) attended the workshops. The survey identified areas for improvement, which included time of disinfectant application, volume of blood to be cultured, and disinfection of BC bottle tops. Of the 9903 BC sets that were drawn from 3649 patients during the study period, 676 (6.8%) were contaminated. The monthly BC contamination rates for the 6-month pre- and post-intervention periods were 8.1% and 5.2%, respectively, representing a 36% reduction (P=0.008). Only three wards had an acceptable contamination rate of ≤3% before the intervention, compared with eight wards after the intervention. While contamination of BCs can never be completely eliminated, there is evidence that adherence to best practice BC collection techniques can minimize BC contamination, which might be best achieved with a dedicated phlebotomy team.
White, Douglas; Rosenzweig, Margaret; Chu, Edward; Moore, Charity; Ellis, Peter; Nikolajski, Peggy; Ford, Colleen; Tiver, Greer; McCarthy, Lauren; Arnold, Robert
Abstract Background: Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics. Objective: The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care. Methods: The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness. Results: The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer. Conclusion: An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted. PMID:25517219
Svensson, Annemarie Lyng; Løgstrup, Brian Bridal; Giraldi, Annamaria; Graugaard, Christian; Blegvad, Jesper; Thygesen, Tina; Sheetal, Ekta; Svendsen, Lone; Emmertsen, Henrik
Introduction Cardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD) in patients with early RA fulfilling the 2010 American College of Rheumatology European League Against Rheumatism (ACR/EULAR) criteria. Methods and analysis The study is a prospective, randomised, open label trial with blinded end point assessment and balanced randomisation (1:1) conducted in 10 outpatient clinics in Denmark. The primary end point after 5 years of follow-up is a composite of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke and cardiac revascularisation. Secondary outcomes are: the proportion of patients achieving low-density lipoprotein cholesterol <2.5 mmol/L, glycated haemoglobin <48 mmol/mol, blood pressure <140/90 mm Hg for patients without diabetes and <130/80 mm Hg for patients with diabetes and normoalbuminuria (urinary albumin creatinine ratio <30 mg/g) after 1 year of follow-up and the proportion of patients in each treatment group achieving low RA disease activity after 1 year, defined as a disease activity score C-reactive protein (DAS28-CRP) <3.2 and a DAS28-CRP score <2.6 after 12, 24 and 60 months. Furthermore, all hospitalisations for acute and elective reasons will be adjudicated by the event committee after 12, 24 and 60 months. Three hundred treatment-naive patients with early RA will be randomly assigned (1:1) to receive either conventional treatment administered and monitored by their general practitioner according to national guidelines (control group) or a stepwise implementation administered and monitored in a quarterly rheumatological nurse-administered set-up of behaviour modification and pharmacological therapy targeting (1) hyperlipidaemia, (2) hypertension, (3) hyperglycaemia
Junqueira, Marcelle Aparecida de Barros; Rassool, G Hussein; Santos, Manoel Antônio dos; Pillon, Sandra Cristina
Nurses are the prime movers in the prevention and harm reduction in alcohol-related harm especially for those patients who are unwilling to access specialist care. The aim of the study is to evaluate the attitudes and knowledge of nursing students before and after Brief Intervention Training for alcohol problems. A quasi-experimental study was conducted with 120 undergraduate nursing students. Sixty recruited students were randomized into experimental and control groups (n = 60 each). Participants completed questionnaires on knowledge and attitudes before and after this training of brief intervention. The brief intervention program, 16 hours of duration, includes training for screening and early recognition, nursing, and the treatment of alcohol problems. Analysis of the data showed statistically significant positive change in the nursing students' knowledge (identifications and care) and personal and professional attitudes in working with patients with alcohol problems after the educational intervention. The experimental group differed significantly in all the variables measured at posteducational program. The provision of educational program on brief intervention in undergraduate nursing education can be an effective way for acquisition of knowledge and changes in attitudes in working with patients with alcohol problems.
Karpavičiūtė, Simona; Macijauskienė, Jūratė
Over 59 million workers are employed in the healthcare sector globally, with a daily risk of being exposed to a complex variety of health and safety hazards. The purpose of this study was to investigate the impact of arts activity on the well-being of nursing staff. During October–December 2014, 115 nursing staff working in a hospital, took part in this study, which lasted for 10 weeks. The intervention group (n = 56) took part in silk painting activities once a week. Data was collected using socio-demographic questions, the Warwick-Edinburgh Mental Well-Being Scale, Short Form—36 Health Survey questionnaire, Reeder stress scale, and Multidimensional fatigue inventory (before and after art activities in both groups). Statistical data analysis included descriptive statistics (frequency, percentage, mean, standard deviation), non-parametric statistics analysis (Man Whitney U Test; Wilcoxon signed—ranks test), Fisher’s exact test and reliability analysis (Cronbach’s Alpha). The level of significance was set at p ≤ 0.05. In the intervention group, there was a tendency for participation in arts activity having a positive impact on their general health and mental well-being, reducing stress and fatigue, awaking creativity and increasing a sense of community at work. The control group did not show any improvements. Of the intervention group 93% reported enjoyment, with 75% aspiring to continue arts activity in the future. This research suggests that arts activity, as a workplace intervention, can be used to promote nursing staff well-being at work. PMID:27104550
Peery, Annette I; Engelke, Martha Keehner; Swanson, Melvin S
Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this relationship in a sample of 69 school-age children who received case management from school nurses. Our findings suggest that teachers and parents do not always agree on how well a child manages their illness. When school nurses provide more education and counseling, parents are more likely to perceive an improvement in their child's self-management. Teachers are more likely to perceive an improvement when the nurse provides more classroom visits and includes the physical education teacher and guidance counselor. These findings suggest that the roles of educator, counselor, and collaborator are important for school nurses who provide care to school-age children with diabetes.
Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Mukamel, Dana; Eggert, Gerald M.
Purpose: We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management-health-promotion nurse intervention, on the probability of use of two types of home care-skilled home health care and personal assistance services-received by functionally impaired Medicare…
Meng, Hongdao; Wamsley, Brenda R.; Eggert, Gerald M.; Van Nostrand, Joan F.
Context: Patients with heart conditions in rural areas may have different responses to health promotion-disease Self-management interventions compared to their urban counterparts. Purpose: To estimate the impact of a multi-component health promotion nurse intervention on physical function and total health care expenditures among elderly adults…
Boisvert, Sophie; Proulx-Belhumeur, Alexandra; Gonçalves, Natalia; Doré, Michel; Francoeur, Julie; Gallani, Maria Cecilia
Abstract Objective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness. PMID:26444179
Fawzy, N W
The primary purpose of this study was to determine if a psychoeducational nursing intervention including (a) health education, (b) stress management, and (c) the teaching of coping skills could enhance the coping behavior and affective state of newly diagnosed Stage I/II malignant melanoma patients. The secondary purpose was to determine if this intervention could be implemented by a nurse and integrated into the overall patient care program. Sixty-one patients were randomized to a control condition or an experimental condition that received and educational manual plus 3 h of individual nurse teaching. Despite randomization, experimental patients had significantly higher baseline distress. By 3 months there was a complete reversal of the baseline trend in Profile of Mood States (POMS) total mood disturbance (TMD), suggesting that the experimental subjects were experiencing less distress over time. Between-group analysis of change scores found significant decreases in experimental subjects for POMS TMD, fatigue, and Brief Symptom Index (BSI) somatization. Within-group analysis found significant experimental decreases for BSI somatization, anxiety, grand total, General Severity Index, and Positive Symptom Distress Index as well as for POMS anxiety, fatigue, confusion, vigor, and TMD. No significant changes were found for controls. Experimental patients were using significantly fewer ineffective passive resignation coping strategies than controls at 3 months.
Bradford, Althea Betty
A short-term intervention on participants' knowledge of cultural competence was provided to 38 students in a baccalaureate nursing program at Winston-Salem State University (WSSU). The study examined the effectiveness of this intervention. Although WSSU is a Historically Black University, the majority of students in this program were White. Six tools were used for data collection. The Cultural Competence Survey consisted of 19 Likert Scale items that also gave participants an opportunity to elaborate on each response. Four tools allowed participants to provide written answers to prompts related to cultural competence. The final tool made it possible for the investigator to record impressions and reflections regarding various aspects of the study. Results showed that the students are familiar with cultural competence and want to avoid stereotypical behavior in their nurse-patient encounters. The study suggests a need for education in cultural competence in three areas: 1) accepting that cultural competence is a lifelong endeavor, 2) understanding patients from a holistic perspective, and 3) recognizing that all people have biases; however, the competent nurse is self-aware and has been educated to recognize biased behavior.
Bronken, Berit Arnesveen; Kirkevold, Marit; Martinsen, Randi; Wyller, Torgeir Bruun; Kvigne, Kari
The psychosocial adjustment process after stroke is complicated and protracted. The language is the most important tool for making sense of experiences and for human interplay, making persons with aphasia especially prone to psychosocial problems. Persons with aphasia are systematically excluded from research projects due to methodological challenges. This study explored how seven persons with aphasia experienced participating in a complex nursing intervention aimed at supporting the psychosocial adjustment process and promoting psychosocial well-being. The intervention was organized as an individual, dialogue-based collaboration process based upon ideas from "Guided self-determination." The content addressed psychosocial issues as mood, social relationships, meaningful activities, identity, and body changes. Principles from "Supported conversation for adults with aphasia" were used to facilitate the conversations. The data were obtained by participant observation during the intervention, qualitative interviews 2 weeks, 6 months, and 12 months after the intervention and by standardized clinical instruments prior to the intervention and at 2 weeks and 12 months after the intervention. Assistance in narrating about themselves and their experiences with illness, psychological support and motivation to move on during the difficult adjustment process, and exchange of knowledge and information were experienced as beneficial and important by the participants in this study. PMID:22888417
Bronken, Berit Arnesveen; Kirkevold, Marit; Martinsen, Randi; Wyller, Torgeir Bruun; Kvigne, Kari
The psychosocial adjustment process after stroke is complicated and protracted. The language is the most important tool for making sense of experiences and for human interplay, making persons with aphasia especially prone to psychosocial problems. Persons with aphasia are systematically excluded from research projects due to methodological challenges. This study explored how seven persons with aphasia experienced participating in a complex nursing intervention aimed at supporting the psychosocial adjustment process and promoting psychosocial well-being. The intervention was organized as an individual, dialogue-based collaboration process based upon ideas from “Guided self-determination.” The content addressed psychosocial issues as mood, social relationships, meaningful activities, identity, and body changes. Principles from “Supported conversation for adults with aphasia” were used to facilitate the conversations. The data were obtained by participant observation during the intervention, qualitative interviews 2 weeks, 6 months, and 12 months after the intervention and by standardized clinical instruments prior to the intervention and at 2 weeks and 12 months after the intervention. Assistance in narrating about themselves and their experiences with illness, psychological support and motivation to move on during the difficult adjustment process, and exchange of knowledge and information were experienced as beneficial and important by the participants in this study. PMID:22888417
Martinez López, Constancio; Martinez de Pinillos, Rafael López; Pereira Torres, Ana Isabel; San Pedro, Ana Isabel Castro; Heras Agudo, Dolores; Robledo González, Ascensión; Olmo Alonso, Carmen; Trujillo Orcha, Natalia
It is after the implementation of the new nursing evaluation/ planning care registers (PCE) in the medical record and the updating of the document/circuit of the All-clear Ensuing Care Report (ICCA) with NANDA, NOC, NIC (NNN) in the first months of the year 2013, that we are contemplating the fulfillment of a descriptive/cross-section study so as to know diagnostics, results and nursing interventions upon discharge of high-risk chronically ill patients and qualitatively in medical hospitalization units and in palliative care. The results obtained at a quantitative level, with an implementation degree of 83 and 94 per cent, respectively, are extremely encouraging. Regarding the quality of care planning, we have identified for the first time in our hospital both the NANDA, the NOC and NIC with the prevalence degree in the units studied.
Jakobsson, L; Hallberg, I R; Lovén, L; Ottosson, B
After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse-patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.
De Bourdeaudhuij, Ilse; Verloigne, Maite; Oenema, Anke; Crombez, Geert
Background Chronic diseases are the principal cause of morbidity and mortality worldwide. An increased consumption of vegetables and fruit reduces the risk of hypertension, coronary heart disease, stroke, and cancer. An increased fruit and vegetable (FV) intake may also prevent body weight gain, and therefore indirectly affect type 2 diabetes mellitus. Insufficient physical activity (PA) has been identified as the fourth leading risk factor for global mortality. Consequently, effective interventions that promote PA and FV intake in a large number of people are required. Objective To describe the systematic development of an eHealth intervention, MyPlan 1.0, for increasing FV intake and PA. Methods The intervention was developed following the six steps of the intervention mapping (IM) protocol. Decisions during steps were based upon available literature, focus group interviews, and pilot studies. Results Based on needs assessment (Step 1), it was decided to focus on fruit and vegetable intake and physical activity levels of adults. Based on self-regulation and the health action process approach model, motivational (eg, risk awareness) and volitional (eg, action planning) determinants were selected and crossed with performance objectives into a matrix with change objectives (Step 2). Behavioral change strategies (eg, goal setting, problem solving, and implementation intentions) were selected (Step 3). Tablet computers were chosen for delivery of the eHealth program in general practice (Step 4). To facilitate implementation of the intervention in general practice, GPs were involved in focus group interviews (Step 5). Finally, the planning of the evaluation of the intervention (Step 6) is briefly described. Conclusions Using the IM protocol ensures that a theory- and evidence-based intervention protocol is developed. If the intervention is found to be effective, a dynamic eHealth program for the promotion of healthy lifestyles could be available for use in general
Tärnhuvud, Marie; Wändel, Cilla; Willman, Ania
The aim of this study was to investigate what nurses do to improve the health of men who are receiving radiotherapy treatment due to prostate cancer. The method was a literature review using a systematic approach. The Cochrane Library, Medline and CINAHL databases were used in a search that covered the period from January 1994 to April 2006. The screening of 200 abstracts resulted in 14 articles corresponding to the research question, which were assessed according to scientific quality. Two independent reviewers performed the screening and quality assessment process using specific protocols. Two themes emerged: nurse-led care related to radiotherapy treatment and patients' experiences of radiotherapy treatment. The results show that there is strong scientific support for nurse-led follow-up care aimed at assisting patients by means of providing information on how to manage side effects (evidence grade A). In addition, there is moderate scientific support for the need to ensure that this information is structured, objective and concrete and that it can be provided by means of audiotapes or over the phone (evidence grade B) as well as weak scientific support for reporting patients' experiences of radiotherapy treatment (evidence grade C).
Campbell, Emily B; And Others
Nursing staff (n=166) in four nursing homes participated in quasi-experimental study to measure knowledge and attitudes about urinary incontinence and compliance with toileting protocols. Intervention group (n=96) showed slight increase in knowledge; their attitudes remained positive over four testing times. Compliance with protocol was only 72…
O'Connor, Siobhan; Andrews, Tom
Mobile applications (apps) to train health professionals is gaining momentum as the benefits of mobile learning (mLearning) are becoming apparent in complex clinical environments. However, most educational apps are generic, off-the-shelf pieces of software that do not take into consideration the unique needs of nursing students. The proposed study will apply a user-centred design process to create a tailored mobile app for nursing students to learn and apply clinical skills in practice. The app will be piloted and evaluated to understand how nursing students use mobile technology in clinical settings to support their learning and educational needs. PMID:27332433
Manongi, Rachel N; Nasuwa, Fortunata R; Mwangi, Rose; Reyburn, Hugh; Poulsen, Anja; Chandler, Clare IR
Background Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. Methods The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention. Results During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including
Onieva-Zafra, María Dolores; Castro-Sánchez, Adelaida María; Matarán-Peñarrocha, Guillermo A; Moreno-Lorenzo, Carmen
Primary fibromyalgia, a poorly understood chronic pain syndrome, is a disorder of uncertain etiology. The ultimate goal of fibromyalgia treatment is to develop a multimodal therapy. In recent years, the use of music as an intervention for the pain management and other symptoms has increased. The purpose of this study was to investigate the effects of music on pain and depression for people diagnosed with fibromyalgia using Rogers' theory of the unitary human being as the theoretical framework. An experimental 4-week longitudinal trial design was undertaken. Sixty patients diagnosed with fibromyalgia were randomly assigned to either a music intervention group or a control group. Music interventions consisted of listening to music once a day for 4 consecutive weeks using two types of CDs. Pain was measured with the McGill Pain Questionnaire Long Form and depression with the Beck inventory; a 100-mm visual analog scale was used to measure pain and depression. The treatment group reported a significant reduction in pain and depression at week 4 compared with the control group. Members of the control group reported no differences in pain. The findings of this pilot study suggest the importance of music therapy as a nursing intervention and justify further investigation into music as a self-management intervention to reduce pain and depression.
Background The advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical leadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to lack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing health service delivery models are driving the emergence of new nursing roles, further clouding the waters related to role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse Consultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse Consultant role and its impact in metropolitan and rural New South Wales (NSW) Australia. Design The proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to explore how Nurse Consultants contribute to organisational outcomes. The ‘context – mechanism – outcome’ approach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted nature of the Nurse Consultant’s role. Method Participants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural and metropolitan services. A modified and previously validated survey will be used providing information related to role characteristics, patterns and differences across health context. Focus groups with Nurse Consultant’s explore issues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to achieve understanding of how the role is viewed and enacted across a range of groups and contexts. Discussion Lack of role clarity is highlighted extensively in international and Australian studies examining the role of the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and complex health services or to examine the role in detail. Such examination
Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic
George, Jyothis T; Valdovinos, Abel Peña; Thow, Jonathan C; Russell, Ian; Dromgoole, Paul; Lomax, Sarah; Torgerson, David J; Wells, Tony
Background Self management is the cornerstone of effective preventive care in diabetes. Educational interventions that provide self-management skills for people with diabetes have been shown to reduce blood glucose concentrations. This in turn has the potential to reduce rates of complications. However, evidence to support type, quantity, setting and mode of delivery of self-management education is sparse. Objectives: To study the biophysical and psychological effectiveness of a brief psycho-educational intervention for type 1 diabetes in adults. Methods/Design Design: Randomised controlled clinical trial. Setting: Multidisciplinary specialist diabetes centre. Hypothesis: Our hypothesis was that the brief (2.5-day) intervention would be biophysically and psychologically effective for people with type 1 diabetes. Intervention: A brief psycho-educational intervention for type 1 diabetes developed by a multi-professional team comprising of a consultant diabetologist, a diabetes specialist nurse, a specialist diabetes dietician and a clinical health psychologist and delivered in 20 hours over 2.5 days. Primary outcomes: HbA1c and severe hypoglycaemia. Secondary outcomes: Blood pressure, weight, height, lipid profile and composite psychometric scales. Participants: We shall consent and recruit 120 subjects with postal invitations sent to eligible participants. Volunteers are to be seen at randomisation clinics where independent researcher verify eligibility and obtain consent. We shall randomise 60 to BITES and 60 to standard care. Eligibility Criteria: Type 1 diabetes for longer than 12 months, multiple injection therapy for at least two months, minimum age of 18 and ability to read and write. Randomisation: An independent evaluator to block randomise (block-size = 6), to intervention or control groups using sealed envelopes in strict ascendant order. Control group will receive standard care. Assessment: Participants in both groups would attend unblinded assessments at
Background Delirium (or acute confusion) is a serious illness common in older people, in which a person’s thinking and perceptions may be affected. Reducing delirium is important because of the considerable distress it causes, and the poor outcomes associated with it, such as increased admissions to hospital, falls, mortality and costs to the National Health Service (NHS). Preventing delirium is possible using multicomponent interventions; successful interventions in hospitals have reduced it by one-third. However, there is little research to guide practice in care homes, where it is common because of the clustering of known risk factors (older age, frailty, and dementia). In previous work we developed a multicomponent intervention to prevent delirium in care homes, called Stop Delirium! The intervention was based upon evidence from the research literature relating to the prevention of delirium and on strategies to change professional practice. Before starting a large costly trial of Stop Delirium!, this pilot study will test and help improve the design and feasibility of the trial protocol. Methods/Design We plan to conduct a cluster randomised pilot trial in 14 care homes (independent residential and nursing). Following recruitment of residents (over 60 years, consenting or with consultee agreement, able to communicate in English, and not in palliative care) participating homes will be randomised, stratified by size of home and proportion of residents with dementia. Stop Delirium! will be delivered to intervention homes over 16 months, with controls receiving usual care. The primary outcome measure will be the presence of delirium on any day during a one-month post-intervention period. We will collect data to determine 1) recruitment and attrition rates, 2) feasibility of various outcomes measurements, and 3) feasibility of capturing health resource use (resident diaries and by examining health records). We will estimate the between-cluster variation for the
Spagnol, Carla Aparecida; L'Abbate, Solange; Monceau, Gilles; Jovic, Ljiljana
The aims of this paper is to describe and to analyze the use of a socioanalytical device as a data collection too as well as a space of professional practice and work relations analysis, with nurses from a School Hospital of the Minas Gerais Federal University, Brazil. The qualitative approach was chosen to develop an intervention research with Institutional Analysis as theoretical and methodological framework. In the first stage of data collection, an exploratory research was carried out through a questionnaire and, in the second phase, a socianalytical device was built in 5 meetings that took place during two months. For the nurses, the analysis device has enabled personal and professional growth; to review positions; to exchange experience and to reflect on their own problems through the experience of other colleagues. We conclude that the socioanalytical device was a space for discussion, for analysis of professional practice and was the methodological strategy for data collection in this research. It has allowed the creation and recreation of forms of intervention, the production of knowledge and has improved quality of health work.
Lane, Mary Rockwood
This article describes an advanced intervention for spiritual healing that evolved from spirit-body healing, a hermeneutic phenomenological research study. The research study examined the lived experience of art and healing with cancer patients in the Arts in Medicine program at Shands Hospital, University of Florida. Max Van Manen's method of researching the lived experience was used in 63 patients over a 4-year period. Healing themes that emerged from the research were (1) go into darkness, (2) go elsewhere, (3) art becomes the turning point, (4) slip through the veil, (5) know the truth and trust the process, (6) embody your spirit, (7) feel the healing energy of love and compassion, and (8) experience transcendence. The intervention we offer allows nurses to apply creativity and guided imagery as advanced therapeutics and to continue to provide the leadership needed for integrating spiritual healing into patient care. It is one that personifies the nursing mission formalized by many hospitals: a commitment to treat the bodies, minds, and spirits of patients to the best of our ability as part of our routine care.
Dinç, L; Erdil, F
Catheter-related infections are one of the most serious complications of TPN therapy. Nurses have important responsibilities in the care of patients who are receiving TPN. This quasi-experimental study was conducted for the purpose of investigating the effectiveness of an educational intervention on changing nursing practice and preventing catheter-related infections in patients receiving total parenteral nutrition. The nurses' practice and the colonisation rate of control and comparative group patients in the surgical clinics of Hacettepe University Hospital (Turkey), and related variables were examined before and after an educational intervention. The findings of the study indicate that the intervention was successful in improving appropriate nursing practice, mean scores of nurses' practices were 45.7 before and 66.5 after the intervention (p<0.05). The rate of microorganism colonisation was also decreased but statistical analysis demonstrated no association between nursing practices and microorganism colonisation of catheter cultures.
Introduction Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation. Methods This was a two-phase (before-after), prospective controlled study at a university-affiliated, 14-bed neurointensive care unit in Denmark. The sample included patients requiring mechanical ventilation for at least 48 hours treated with continuous sedative and analgesic infusions or both. During the observation phase the participants (n = 106) were sedated as usual (non-protocolized), and during the intervention phase the participants (n = 109) were managed according to a new sedation protocol. Results Our study showed a shift toward analgo-sedation, suggesting feasibility of the protocol. We found a significant reduction in the use of propofol (P < .001) and midazolam (P = .001) and an increase in fentanyl (P < .001) and remifentanil (P = .003). Patients selected for daily sedation interruption woke up faster, and estimates of pain free patients increased from 56.8% to 82.7% (P < .001), suggesting efficacy of the protocol. The duration of sedation and unplanned extubations were unchanged. Conclusions Our pilot study showed feasibility and partial efficacy of our protocol. Some neurointensive patients might not benefit from protocolized practice. We recommend an interdisciplinary effort to target patients requiring less sedation, as issues of oversedation and inadequate pain management still need more attention. Trial registration ISRCTN80999859. PMID:20403186
Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U
Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.
Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.
Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218
Broyles, Lauren M; Kraemer, Kevin L; Kengor, Caroline; Gordon, Adam J
A package of clinical strategies known as alcohol screening, brief intervention, and referral to treatment (SBIRT) is increasingly recommended for reducing unhealthy alcohol use, the spectrum of alcohol consumption from at-risk drinking (defined as consumption above recommended guidelines) to alcohol abuse and alcohol dependence. The United States' Joint Commission issued new SBIRT-related hospital accreditation measures for alcohol. Ongoing initiatives aim to promote, support, and sustain SBIRT implementation in hospital settings. In hospital settings, nurse-delivered SBIRT may be a particularly viable and efficient model for SBIRT implementation. However, like physicians, most nurses have not been trained in how to perform SBIRT, and few authors have described alcohol-related curricula specifically for nurses. In addition, historical differences in nurse and physician professional scopes of practice, role perceptions, and patterns of care delivery suggest the need for effective SBIRT initial and continuing education and training that are tailored to the nursing profession and inpatient environments. In this article, we provide an in-depth description of the registered nurse SBIRT curriculum and describe its development and contents as well as various nurse- and setting-specific adaptations. In addition, we describe how we engaged nursing stakeholders in the development and implementation of the curriculum and discuss potential implications for future SBIRT training and delivery by nurses. SBIRT continuing education and training for nurses represents one of the first steps in expanded SBIRT implementation. Comprehensive workforce and organizational development of inpatient and nurse-delivered SBIRT may provide the means to address the entire spectrum of unhealthy alcohol use across healthcare settings.
Murray, Sonya R; Murchie, Peter; Campbell, Neil; Walter, Fiona M; Mazza, Danielle; Habgood, Emily; Kutzer, Yvonne; Martin, Andrew; Goodall, Stephen; Barnes, David J
Introduction Lung cancer is the most common cancer worldwide, with 1.3 million new cases diagnosed every year. It has one of the lowest survival outcomes of any cancer because over two-thirds of patients are diagnosed when curative treatment is not possible. International research has focused on screening and community interventions to promote earlier presentation to a healthcare provider to improve early lung cancer detection. This paper describes the protocol for a phase II, multisite, randomised controlled trial, for patients at increased risk of lung cancer in the primary care setting, to facilitate early presentation with symptoms of lung cancer. Methods/analysis The intervention is based on a previous Scottish CHEST Trial that comprised of a primary-care nurse consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to improve symptom appraisal and encourage help-seeking in patients at increased risk of lung cancer. We aim to recruit 550 patients from two Australian states: Western Australia and Victoria. Patients will be randomised to the Intervention (a health consultation involving a self-help manual, monthly prompts and spirometry) or Control (spirometry followed by usual care). Eligible participants are long-term smokers with at least 20 pack years, aged 55 and over, including ex-smokers if their cessation date was less than 15 years ago. The primary outcome is consultation rate for respiratory symptoms. Ethics and dissemination Ethical approval has been obtained from The University of Western Australia's Human Research Ethics Committee (RA/4/1/6018) and The University of Melbourne Human Research Committee (1 441 433). A summary of the results will be disseminated to participants and we plan to publish the main trial outcomes in a single paper. Further publications are anticipated after further data analysis. Findings will be presented at national and international conferences from late 2016. Trial
Background Although the number of smokers has declined in the last decade, smoking is still a major health problem among youngsters and adolescents. For this reason, there is a need for effective smoking prevention programmes targeting primary school children. A web-based computer-tailored feedback programme may be an effective intervention to stimulate youngsters not to start smoking, and increase their knowledge about the adverse effects of smoking and their attitudes and self-efficacy regarding non-smoking. Methods & design This paper describes the development and evaluation protocol of a web-based out-of-school smoking prevention programme for primary school children (age 10-13 years) entitled ‘Fun without Smokes’. It is a transformation of a postal mailed intervention to a web-based intervention. Besides this transformation the effects of prompts will be examined. This web-based intervention will be evaluated in a 2-year cluster randomised controlled trial (c-RCT) with three study arms. An intervention and intervention + prompt condition will be evaluated for effects on smoking behaviour, compared with a no information control condition. Information about pupils’ smoking status and other factors related to smoking will be obtained using a web-based questionnaire. After completing the questionnaire pupils in both intervention conditions will receive three computer-tailored feedback letters in their personal e-mail box. Attitudes, social influences and self-efficacy expectations will be the content of these personalised feedback letters. Pupils in the intervention + prompt condition will - in addition to the personalised feedback letters - receive e-mail and SMS messages prompting them to revisit the ‘Fun without Smokes’ website. The main outcome measures will be ever smoking and the utilisation of the ‘Fun without Smokes’ website. Measurements will be carried out at baseline, 12 months and 24 months of follow-up. Discussion The present study
Ezendam, Nicole PM; Oenema, Anke; van de Looij-Jansen, Petra M; Brug, Johannes
Background Computer tailoring may be a promising technique for prevention of overweight in adolescents. However, very few well-developed, evidence-based computer-tailored interventions are available for this target group. We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours: i.e. consumption of snacks, sugar-sweetened beverages, fruit, vegetables, and fibre, physical activity, and sedentary behaviours. This paper describes the planned development of a school-based computer-tailored intervention aimed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents, and the protocol for evaluating this intervention. Methods/design Intervention development: Informed by the Precaution Adoption Process Model and the Theory of Planned Behaviour, the computer-tailored intervention provided feedback on personal behaviour and suggestions on how to modify it. The intervention (VETisnietVET translated as 'FATaintPHAT') has been developed for use in the first year of secondary school during eight lessons. Evaluation design: The intervention will be evaluated in a cluster-randomised trial including 20 schools with a 4-months and a 2-years follow-up. Outcome measures are BMI, waist circumference, energy balance-related behaviours, and potential determinants of these behaviours. Process measures are appreciation of and satisfaction with the program, exposure to the program's content, and implementation facilitators and barriers measured among students and teachers. Discussion This project resulted in a theory and evidence-based intervention that can be implemented in a school setting. A large-scale randomised controlled trial with a short and long-term follow-up will provide sound statements about the effectiveness of this computer-tailored intervention in adolescents. Trial Registration ISRCTN15743786 PMID:17997834
Awbrey, Lucinda Mejdell; Juarez, Sandra M.
Management of medications in school is one of the critical roles that school nurses carry out in the school setting. In recent years, parents have come to question the medication procedures that school districts follow. Parents question why a physician's order is required for school personnel to provide over-the-counter (OTC) medications to their…
Background Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system. In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the “Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care” (SMADS)-Study. Methods/Design The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment. Discussion The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance
Background The aim of the present research is to conduct a fully powered explanatory trial to evaluate the efficacy of a brief self-regulation intervention to increase walking. The intervention will be delivered in primary care by practice nurses (PNs) and Healthcare Assistants (HCAs) to patients for whom increasing physical activity is a particular priority. The intervention has previously demonstrated efficacy with a volunteer population, and subsequently went through an iterative process of refinement in primary care, to maximise acceptability to both providers and recipients. Methods/ Design This two arm cluster randomised controlled trial set in UK general practices will compare two strategies for increasing walking, assessed by pedometer, over six months. Patients attending practices randomised to the self-regulation intervention arm will receive an intervention consisting of behaviour change techniques designed to increase walking self-efficacy (confidence in ability to perform the behaviour), and to help people translate their "good" intentions into behaviour change by making plans. Patients attending practices randomised to the information provision arm will receive written materials promoting walking, and a short unstructured discussion about increasing their walking. The trial will recruit 20 PN/HCAs (10 per arm), who will be trained by the research team to deliver the self-regulation intervention or information provision control intervention, to 400 patients registered at their practices (20 patients per PN/HCA). This will provide 85% power to detect a mean difference of five minutes/day walking between the self-regulation intervention group and the information provision control group. Secondary outcomes include health services costs, and intervention effects in sub-groups defined by age, ethnicity, gender, socio-economic status, and clinical condition. A mediation analysis will investigate the extent to which changes in constructs specified by the
The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity. PMID:16913237
dos Santos, Raquel Bezerra; Ramos, Karla da Silva
This is a descriptive and exploratory study with a quantitative approach, aiming to propose a protocol for the systematization of nursing care to women in the process of giving birth in the Obstetrical Center of a public hospital in Recife, Pernambuco, Brazil. A semi-structured instrument was applied to forty women in the process of giving birth, in order to obtaining the nursing history; from which the nursing diagnoses were identified, having as a basis the International Classification for Nursing Practice (ICNP®), version 1, and their respective results and nursing interventions were established. The protocol consists in two stages: the first one is the nursing consultation, which involves the anamnesis and physical examination; and the second, involves the judicious identification of the nursing diagnoses, which will guide the planning of the nursing care to provide the individualized attention to women in the process of giving birth, using a universal terminology.
Lagarde, Mylene; Blaauw, Duane; Cairns, John
Recent policy recommendations have called for increased research efforts to inform the design of cost-effective interventions to address the shortage of health workers in rural areas. This paper takes forward the recent use of Discrete Choice Experiments to assess the effects of potential incentives to attract nurses to rural areas. The analysis relies on data collected in South Africa between August and November 2008. Effectiveness measures derived from Discrete Choice Experiments are combined in a Markov model to derive the long-term effects of policies, and costs are evaluated with secondary data. Measures involving the selection of more nursing students who are more likely to accept positions in rural areas are shown to be the most cost-effective interventions. If such policies could not be implemented, the next best options are to offer preferential access to specialist training to nurses willing to work in rural areas.
Jameson, Paula R
Baccalaureate nursing education is stressful. The stress encompasses a range of academic, personal, clinical, and social reasons. A hardiness educational program, a tool for stress management, based on theory, research, and practice, exists to enhance the attitudes and coping strategies of hardiness (Maddi, 2007; Maddi et al., 2002). Research has shown that students who completed the hardiness educational program, subsequently improved in grade point average (GPA), college retention rates, and health (Maddi et al., 2002). Little research has been done to explore the effects of hardiness education with junior baccalaureate nursing students. Early identification of hardiness, the need for hardiness education, or stress management in this population may influence persistence in and completion of a nursing program (Hensel and Stoelting-Gettelfinger, 2011). Therefore, the aims were to determine if an increase in hardiness and a decrease in perceived stress in junior baccalaureate nursing students occurred in those who participated in a hardiness intervention. The application of the Hardiness Model and the Roy Adaptation Model established connections and conceptual collaboration among stress, stimuli, adaptation, and hardi-coping. A quasi-experimental non-equivalent control group with pre-test and post-test was used with a convenience sample of full-time junior level baccalaureate nursing students. Data were collected from August 2011 to December 2011. Results of statistical analyses by paired t-tests revealed that the hardiness intervention did not have a statistically significant effect on increasing hardiness scores. The hardiness intervention did have a statistically significant effect on decreasing perceived stress scores. The significant decrease in perceived stress was congruent with the Hardiness Model and the Roy Adaptation Model. Further hardiness research among junior baccalaureate nursing students, utilizing the entire hardiness intervention, was recommended.
Raman, Siva P; Raminpour, Sara; Horton, Karen M; Fishman, Elliot K
The iPad, iPhone, and other portable devices offer a unique opportunity for radiology education, allowing presentation of information in a simple, concise, and mobile fashion to large groups of learners. The CT Contrast Protocols application for the iPad and iPhone is one of the first radiology applications in the Apple App Store to focus on radiology education and was designed to address the lack of practical information on contrast media for radiologists, technologists, nurses, and trainees. The application was developed in response to questions about contrast media use from clinicians, technologists, and nurses; its content is based on questions from these members of the authors' department and hospital, as well as users of the CTisus.com Web site. The application uses a simple interface that requires no training and can be easily navigated by those who have only recently begun using an iPad or iPhone. It provides simple, easily understood answers to many common questions about contrast media use, all arranged under several subject headings. The application is constantly evolving and represents an aggregate of the knowledge found in the literature, the American College of Radiology's consensus guidelines, and the institutional practices of the computed tomography division of Johns Hopkins Hospital. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.333125106/-/DC1. PMID:23479681
El-Bahnasawy, Mamdouh M; Elmeniawy, Nagwa Zein El Abdeen A; Morsy, Tosson A
participant had adequate knowledge (> 60% from total score) in the pre-test 94% in the post-test 74% after 3 month with significant difference among pre, post and FU regarding adequate knowledge. Also, there were significant improvement P = < 0.001 of correct knowledge about hypertension, dengue fever, skin scalding & others diseases during pilgrim among nurses at military hospital, the highest improvement was in skin scalding prevention the lowest was in first aid bag. 28% of participant had adequate knowledge (> 60% from total score) in the pre-test 92% in the post-test 61% after 3 month with significant difference among pre, post and FU regarding adequate knowledge. There was a significant difference between total knowledge score according to education, and work experience (P > 0.05). in the pre, post and after 3 month in age and in all intervention time in department the highest was ICU then ward then operation room. PMID:25597156
Kaner, Eileen; Bland, Martin; Cassidy, Paul; Coulton, Simon; Deluca, Paolo; Drummond, Colin; Gilvarry, Eilish; Godfrey, Christine; Heather, Nick; Myles, Judy; Newbury-Birch, Dorothy; Oyefeso, Adenekan; Parrott, Steve; Perryman, Katherine; Phillips, Tom; Shenker, Don; Shepherd, Jonathan
Background There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients. Methods and design GPs and nurses from 24 practices across the North East (n = 12), London and South East (n = 12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n = 8); brief structured advice (n = 8); and brief lifestyle counselling (n = 8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial. Discussion The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will
Ceass, Tasha; Parsons, Lynn C
Tobacco use contributes to the largest proportion of preventable disease, disability, and death. Use of tobacco products is at epidemic proportions in the United States. Estimates retrieved between 2012 and 2013 by the US Centers for Disease Control and Prevention reported that 1 in 5 adults used tobacco products. Tobacco use was greatest among men, young adults, those living in the Midwest and south, and those with less education. Cigarette smoking resulting in inhalation of tobacco and its by-products is the most common form of tobacco use. Tobacco use results in multiple diseases, including numerous cancers and chronic diseases. PMID:26596660
Corbett, Teresa; Walsh, Jane C; Groarke, AnnMarie; Moss-Morris, Rona; McGuire, Brian E
Introduction Many post-treatment cancer survivors experience persistent fatigue that can disrupt attempts to resume normal everyday activities after treatment. Theoretical models that aim to explain contributory factors that initiate and sustain fatigue symptoms, or that influence the efficacy of interventions for cancer-related fatigue (CrF) require testing. Adjustment to fatigue is likely to be influenced by coping behaviours that are guided by the representations of the symptom. Objectives This paper describes the protocol for a pilot trial of a systematically and theoretically designed online intervention to enable self-management of CrF after cancer treatment. Methods and analysis This 2-armed randomised controlled pilot trial will study the feasibility and potential effectiveness of an online intervention. Participants will be allocated to either the online intervention (REFRESH (Recovery from Cancer-Related Fatigue)), or a leaflet comparator. Participants 80 post-treatment cancer survivors will be recruited for the study. Interventions An 8-week online intervention based on cognitive–behavioural therapy. Primary and secondary outcome measures The primary outcome is a change in fatigue as measured by the Piper Fatigue Scale (revised). Quality of life will be measured using the Quality of Life in Adult Survivors of Cancer Scale. Outcome measures will be collected at baseline, and at completion of intervention. Results The feasibility of trial procedures will be tested, as well as the effect of the intervention on the outcomes. Conclusions This study may lead to the development of a supportive resource to target representations and coping strategies of cancer survivors with CrF post-treatment. Setting Recruitment from general public in Ireland. Ethics and dissemination This trial was approved by the Research Ethics Committee at National University of Ireland Galway in January 2013. Trial results will be communicated in a peer-reviewed journal. Trial
Ingoldsby, Erin M.; Baca, Pilar; McClatchey, Maureen W.; Luckey, Dennis W.; Ramsey, Mildred O.; Loch, Joan M.; Lewis, Jan; Blackaby, Terrie S.; Petrini, Mary B.; Smith, Bobbie J.; McHale, Mollie; Perhacs, Marianne; Olds, David L.
We evaluated an intervention to increase participant retention and engagement in community practice settings of the Nurse-Family Partnership (NFP), an evidence-based program of nurse home visiting for low-income, first-time parents. Using a quasi-experimental design (six intervention and 11 controls sites that delivered the NFP), we compared intervention and control sites on retention and number of completed home visits during a 10-month period after the intervention was initiated. Nurses at the 5 intervention sites were guided in tailoring the frequency, duration, and content of the visits to participants’ needs. NFP nurses at the control sites delivered the program as usual. At intervention sites, participant retention and completed home visits increased from the pre-intervention to intervention periods, while at control sites these outcomes decreased from the pre-intervention to intervention periods, leading to a significant intervention-control difference in change in participant retention (Hazard Ratio: 0.42, p = .015) and a 1.4 visit difference in change in completed home visits (p<.001, ES = 0.36). We conclude that training nurse home visitors to promote adaptation of program dosage and content to meet families’ needs shows promise as a way to improve participant retention and completed home visits. PMID:23832657
Wunder, Linda L
Simulation-based education provides a safe place for student registered nurse anesthetists to practice non-technical skills before entering the clinical arena. An anesthetist's lack of nontechnical skills contributes to adverse patient outcomes. The purpose of this study was to determine whether an educational intervention on nontechnical skills could improve the performance of nontechnical skills during anesthesia crisis simulation with a group of first-year student registered nurse anesthetists. Thirty-two first-year students volunteered for this quasi-experimental study. Each subject was videotaped and rated as he or she performed 6 simulated crisis scenarios: 3 scenarios before the intervention and 3 after the intervention. Findings revealed that the nontechnical skills mean posttest score was greater than pretest scores: t (df = 31) = 1.99, P = .028. The mean gain in scores for standardized nontechnical skills were significantly greater than those for standardized technical skills: t (df = 30) = 1.81, P = .04. In conclusion, a 3-hour educational intervention on nontechnical skills resulted in significant improvement. Nontechnical skills therefore are not acquired through experience, but rather through instruction. An educational intervention using the Anaesthetists' Non-Technical Skills system is a valuable tool in the measurement of nontechnical skills assessment of first-year student registered nurse anesthetists. PMID:26939388
Wunder, Linda L
Simulation-based education provides a safe place for student registered nurse anesthetists to practice non-technical skills before entering the clinical arena. An anesthetist's lack of nontechnical skills contributes to adverse patient outcomes. The purpose of this study was to determine whether an educational intervention on nontechnical skills could improve the performance of nontechnical skills during anesthesia crisis simulation with a group of first-year student registered nurse anesthetists. Thirty-two first-year students volunteered for this quasi-experimental study. Each subject was videotaped and rated as he or she performed 6 simulated crisis scenarios: 3 scenarios before the intervention and 3 after the intervention. Findings revealed that the nontechnical skills mean posttest score was greater than pretest scores: t (df = 31) = 1.99, P = .028. The mean gain in scores for standardized nontechnical skills were significantly greater than those for standardized technical skills: t (df = 30) = 1.81, P = .04. In conclusion, a 3-hour educational intervention on nontechnical skills resulted in significant improvement. Nontechnical skills therefore are not acquired through experience, but rather through instruction. An educational intervention using the Anaesthetists' Non-Technical Skills system is a valuable tool in the measurement of nontechnical skills assessment of first-year student registered nurse anesthetists.
LaRose, Patrick S., Sr.
The role of the registered nurse has evolved over the years as technology has changed and the practice of nursing has advanced. There are many factors that influence how a new nurse enters practice; however, confidence appears to play a large role in the way nursing students see themselves and how this self perception regulates transition to…
Bornman, Juan; Alant, Erna; Lloyd, Lyle L.
Primary health care nurses are frequently overlooked when delivering services to children with developmental disabilities, despite the fact that they are often the first contact many primary caregivers have with rehabilitation professionals and usually remain the bridge between caregivers and professionals. A time series one group design with…
Romijn, Anita; de Bruijne, Martine C; Teunissen, Pim W; de Groot, Christianne J M; Wagner, Cordula
Introduction In obstetrics, patients often experience referral situations between different care professionals. In these multidisciplinary teams, a focus on communication and interprofessional collaboration is needed to ensure care of high quality. Crew resource management team training is increasingly being applied in healthcare settings to improve team performance and coordination. Efforts to improve communication also include tools for standardisation such as SBAR (situation, background, assessment, recommendation). Despite the growing adoption of these interventions, evidence on their effectiveness is limited, especially on patient outcomes. This article describes a study protocol to examine the effectiveness of a crew resource management team training intervention aimed at implementing the SBAR tool for structured communication during patient referrals in obstetrical care. Methods and analysis The intervention is rolled out sequentially in five hospitals and surrounding primary care midwifery practices in the Netherlands, using a stepped wedge design. The intervention involves three phases over a period of 24 months: (1) preparation, (2) training and (3) follow-up with repeated measurements. The primary outcomes are perinatal and maternal outcomes calculated using the Adverse Outcome Index. The secondary outcomes are the reaction of participating professionals to the training programme, attitudes towards safety and teamwork (Safety Attitudes Questionnaire), cohesion (Interprofessional Collaboration Measurement Scale), use of the tool for structured communication (self-reported questionnaire) and patient experiences. These secondary outcomes from professional and patient level allow triangulation and an increased understanding of the effect of the intervention on patient outcomes. Ethics and dissemination The study was approved by the Medical Ethical Committee of the VU University Medical Centre in the Netherlands and the protocol is in accordance with Dutch
O'Connor, A M; Anderson, K M; Goodell, C K; Sargeant, J M
This article is the fourth of six articles addressing systematic reviews in animal agriculture and veterinary medicine. Previous articles in the series have introduced systematic reviews, discussed study designs and hierarchies of evidence, and provided details on conducting randomized controlled trials, a common design for use in systematic reviews. This article describes development of a review protocol and the first two steps in a systematic review: formulating a review question, and searching the literature for relevant research. The emphasis is on systematic reviews of questions related to interventions. The review protocol is developed prior to conducting the review and specifies the plan for the conduct of the review, identifies the roles and responsibilities of the review team and provides structured definitions related to the review question. For intervention questions, the review question should be defined by the PICO components: population, intervention, comparison and outcome(s). The literature search is designed to identify all potentially relevant original research that may address the question. Search terms related to some or all of the PICO components are entered into literature databases, and searches for unpublished literature also are conducted. All steps of the literature search are documented to provide transparent reporting of the process.
LI, YANLING; YAO, MEIYING; WANG, XIA; ZHAO, YANQING
Pressure sore pertains to tissue damage or necrosis that occurs due to lack of adequate nutrition following long-term exposure to pressure and decreased blood circulation. The aim of the study was to examine the effects of gelatin sponge combined with moist wound-healing nursing intervention in the treatment of phase III bedsore. In total, 50 patients with phase III bedsore were included in the present study. The patients were randomly divided into the control (n=25) and observation (n=25) groups. Patients in the control group received conventional nursing, while those in the observation group received gelatin sponge combined with moist wound healing nursing. The effects of the two nursing methods were compared and analyzed. The results showed that the improvement rate of the observation group was significantly higher than that of the control group (P<0.05). The Branden score and area of pressure sore of the observation group were significantly lower than those of the control group (P<0.05). The frequency and time of dressing change and the average cost of hospitalization of the observation group were significantly lower than those of the control group (P<0.001). In conclusion, gelatin sponge combined with moist wound-healing nursing intervention may significantly improve the treatment of phase III bedsore. PMID:27313666
There are several protocols in existence that guide clinicians in the implementation of effective, evidence-based psychological interventions for eating disorders. These have been made accessible in the form of treatment manuals. However, relatively few clinicians use those protocols, preferring to offer more eclectic or integrative approaches. Following a summary of the research that shows that these evidence-based approaches can be used successfully in routine clinical settings, this review considers why there is such poor uptake of these therapies in such settings. This review focuses on the role of service culture and on clinicians' own attitudes, beliefs and emotions. Possible means of enhancing uptake are considered, but these cannot be considered to be ideal solutions at present. PMID:26893234
Zhang, Yuan; Flum, Marian; West, Cheryl; Punnett, Laura
The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations.
Zhang, Yuan; Flum, Marian; West, Cheryl; Punnett, Laura
The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations. PMID:25715335
Gagnon, Marie-Pierre; Beogo, Idrissa; Buyl, Ronald
e-Health interventions could contribute to healthy aging (HA) but their effectiveness has not been synthesised. This study aims to systematically review the effectiveness of e-health interventions for supporting HA. We will perform standardized searches to identify experimental and quasi-experimental studies evaluating the effectiveness of e-health interventions for HA. Outcomes of interest are: wellbeing, quality of life, activities of daily living, leisure activities, knowledge, evaluation of care, social support, skill acquisition and healthy behaviours. We will also consider adverse effects such as social isolation, anxiety, and burden on informal caregivers. Two reviewers will independently assess studies for inclusion and extract data using a standardised tool. We will calculate effect sizes related to e-health interventions. If not possible, we will present the findings in a narrative form. This systematic review will provide unique knowledge on the effectiveness of e-health interventions for supporting HA. PMID:27332428
Gagnon, Marie-Pierre; Beogo, Idrissa; Buyl, Ronald
e-Health interventions could contribute to healthy aging (HA) but their effectiveness has not been synthesised. This study aims to systematically review the effectiveness of e-health interventions for supporting HA. We will perform standardized searches to identify experimental and quasi-experimental studies evaluating the effectiveness of e-health interventions for HA. Outcomes of interest are: wellbeing, quality of life, activities of daily living, leisure activities, knowledge, evaluation of care, social support, skill acquisition and healthy behaviours. We will also consider adverse effects such as social isolation, anxiety, and burden on informal caregivers. Two reviewers will independently assess studies for inclusion and extract data using a standardised tool. We will calculate effect sizes related to e-health interventions. If not possible, we will present the findings in a narrative form. This systematic review will provide unique knowledge on the effectiveness of e-health interventions for supporting HA.
Background Despite increased investment in its recognition and treatment, depression remains a substantial health and economic burden worldwide. Current treatment strategies generally focus on biological and psychological pathways, largely neglecting the role of lifestyle. There is emerging evidence to suggest that diet and nutrition play an important role in the risk, and the genesis, of depression. However, there are limited data regarding the therapeutic impact of dietary changes on existing mental illness. Using a randomised controlled trial design, we aim to investigate the efficacy and cost-efficacy of a dietary program for the treatment of Major Depressive Episodes (MDE). Methods/Design One hundred and seventy six eligible participants suffering from current MDE are being randomised into a dietary intervention group or a social support group. Depression status is assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (Non Patient Edition) (SCID-I/NP). The intervention consists of 7 individual nutrition consulting sessions (of approximately 60 minutes), delivered by an Accredited Practising Dietitian (APD). Sessions commence within one week of baseline assessment. The intervention focuses on advocating a healthy diet based on the Australian Dietary Guidelines and the Dietary Guidelines for Adults in Greece. The control condition comprises a befriending protocol using the same visit schedule and length as the diet intervention. The study is being conducted at two locations in Victoria, Australia (a metropolitan and regional centre). Data collection occurs at baseline (pre-intervention), 3-months (post-intervention) and 6– months. The primary endpoint is MADRS scores at 3 months. A cost consequences analysis will determine the economic value of the intervention. Discussion If efficacious, this program could provide an alternative or adjunct treatment
Background Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke. The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and infants. The “5 A’s” (Ask, Advise, Assess, Assist, Arrange) is a strategy consisting of a brief cessation counseling session of 5–15 minutes delivered by a trained provider. The “5 A’s” is considered the standard of care worldwide; however, it is under used in Argentina and Uruguay. Methods We will conduct a two-arm, parallel cluster randomized controlled trial of an implementation intervention in 20 prenatal care settings in Argentina and Uruguay. Prenatal care settings will be randomly allocated to either an intervention or a control group after a baseline data collection period. Midwives’ facilitators in the 10 intervention prenatal clinics (clusters) will be identified and trained to deliver the “5 A’s” to pregnant women and will then disseminate and implement the program. The 10 clusters in the control group will continue with their standard in-service activities. The intervention will be tailored by formative research to be readily applicable to local prenatal care services at maternity hospitals and acceptable to local pregnant women and health providers. Our primary hypothesis is that the intervention is feasible in prenatal clinics in Argentina and Uruguay and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy in the intervention clinics compared to the control clinics. Our secondary hypotheses are that the intervention will decrease the frequency of women who smoke by the end of pregnancy, and that the intervention will increase the attitudes and readiness of midwives towards providing counseling to women in the intervention clinics compared to the control clinics. Trial registration ClinicalTrials.gov. Identifier: NCT01852617 PMID:23971512
Sawyer, Michael G; Reece, Christy E; Bowering, Kerrie; Jeffs, Debra; Sawyer, Alyssa C P; Peters, Jacqueline D; Mpundu-Kaambwa, Christine; Clark, Jennifer J; McDonald, Denise; Mittinty, Murthy N; Lynch, John W
Objectives To identify factors predicting use, adherence and attrition with a nurse-moderated web-based group intervention designed to support mothers of infants aged 0–6 months. Design 9-Month observational study. Setting Community maternal and child health service. Participants 240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%). Intervention In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2–7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers’ groups. During weeks 8–26 (phase III), mothers participated in an extended programme at a frequency of their choosing. Primary outcome measures Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics. Results In phase II, the median number of logins was 9 logins (IQR=1–25), and in phase III, it was 10 logins (IQR=0–39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers’ level of engagement with the intervention than their demographic and psychosocial characteristics. Conclusions Mothers’ early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving
Bogart, Laura M; Mutchler, Matt G; McDavitt, Bryce; Mutepfa, Kieta D; Risley, Brian
Background HIV-positive African Americans have been shown to have lower adherence to antiretroviral therapy (ART) than those of other races/ethnicities, yet adherence interventions have rarely been tailored to the needs of this population. Objective We developed and will evaluate a treatment education adherence intervention (called Rise) that was culturally adapted to address the needs of African Americans living with HIV. Methods This randomized controlled trial will examine the effects of the Rise intervention on ART adherence and HIV viral load. African Americans on ART who report adherence problems will be recruited from the community and randomly assigned to receive the intervention or usual care for 6 months. The intervention consists of 6-10 individual counseling sessions, with more sessions provided to those who demonstrate lower adherence. Primary outcomes include adherence as monitored continuously with Medication Event Monitoring Systems (MEMS) caps, and viral load data received from the participant’s medical provider. Survey assessments will be administered at baseline and month 6. Results The trial is ongoing. Conclusions If effective, the Rise intervention will provide community-based organizations with an intervention tailored to address the needs of African Americans for promoting optimal ART adherence and HIV clinical outcomes. Trial Registration Clinicaltrials.gov NCT01350544; https://clinicaltrials.gov/ct2/show/NCT01350544 (Archived by WebCite at http://www.webcitation.org/6fjqqnmn0). PMID:27025399
Background Depression is common in people with chronic physical illness and is associated with worse medical outcomes. Cognitive behavioural therapy and problem-solving improve depression, although usually have small to moderate effects among people with chronic physical illness. Behavioural activation interventions for depression, which aim to increase positive reinforcement from the environment by encouraging individuals to increase pleasant/rewarding activities, have been reported to be equivalent to cognitive behavioural therapy. However, the effectiveness of behavioural activation interventions for depression in individuals with chronic physical illness is unclear. The aims of this systematic review are to identify the extent to which different forms of behavioural activation have been used as a treatment for depression in this population, examine the effectiveness of the interventions, and identify any adaptations which have been made specifically to the interventions for individuals with a range of chronic physical illnesses. Methods/Design Electronic databases will be systematically searched using terms relevant to behavioural activation and depression, and the subset of studies in people with chronic physical illnesses will be identified by manual searching. References and citations of eligible studies will be searched and experts in this field will be contacted to identify additional papers. All study designs will be included in this review to allow for a more extensive identification of the extent of different forms of behavioural activation interventions. The different forms of behavioural activation and the specific chronic physical health conditions for which this intervention has been used will be reviewed narratively. For the effectiveness of the interventions, if sufficient randomised controlled trials have been undertaken the results will be meta-analysed. Non-randomised studies will be narratively synthesised and adaptations to the interventions
Mody, Lona; Krein, Sarah L.; Saint, Sanjay K.; Min, Lillian C.; Montoya, Ana; Lansing, Bonnie; McNamara, Sara E.; Symons, Kathleen; Fisch, Jay; Koo, Evonne; Rye, Ruth Anne; Galecki, Andrzej; Kabeto, Mohammed U.; Fitzgerald, James T.; Olmsted, Russell N.; Kauffman, Carol A.; Bradley, Suzanne F.
IMPORTANCE Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs. OBJECTIVE To test whether a multimodal targeted infection program (TIP) reduces the prevalence of MDROs and incident device-related infections. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 12 community-based NHs from May 2010 to April 2013. Participants were high-risk NH residents with urinary catheters, feeding tubes, or both. INTERVENTIONS Multimodal, including preemptive barrier precautions, active surveillance for MDROs and infections, and NH staff education. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence density rate of MDROs, defined as the total number of MDROs isolated per visit averaged over the duration of a resident's participation. Secondary outcomes included new MDRO acquisitions and new clinically defined device-associated infections. Data were analyzed using a mixed-effects multilevel Poisson regression model (primary outcome) and a Cox proportional hazards model (secondary outcome), adjusting for facility-level clustering and resident-level variables. RESULTS In total, 418 NH residents with indwelling devices were enrolled, with 34 174 device-days and 6557 anatomic sites sampled. Intervention NHs had a decrease in the overall MDRO prevalence density (rate ratio, 0.77; 95% CI, 0.62–0.94). The rate of new methicillin-resistant Staphylococcus aureus acquisitions was lower in the intervention group than in the control group (rate ratio, 0.78; 95% CI, 0.64–0.96). Hazard ratios for the first and all (including recurrent) clinically defined catheter-associated urinary tract infections were 0.54 (95% CI, 0.30–0.97) and 0.69 (95% CI, 0.49–0.99), respectively, in the intervention group and the control group. There were no reductions in new vancomycin
McDonald, Glenda; Jackson, Debra; Wilkes, Lesley; Vickers, Margaret H
A work-based educational programme was the intervention used in a collective case study aiming to develop, strengthen and maintain personal resilience amongst fourteen nurses and midwives. The participants attended six, monthly workshops and formed a participatory learning group. Post-intervention, participants reported positive personal and professional outcomes, including enhanced self-confidence, self-awareness, communication and conflict resolution skills. They strengthened relationships with their colleagues, enabling them to build helpful support networks in the workplace. The intervention used new and innovative ways of engaging nurses and midwives exhibiting the effects of workplace adversity - fatigue, pressure, stress and emotional labour. Participants were removed from their usual workplace environment and brought together to engage in critical reflection, experiential learning and creativity whilst also learning about the key characteristics and strategies of personal resilience. Participants' experiences and skills were valued and respected; honest airing of the differences within the group regarding common workplace issues and concerns was encouraged. The new contribution of this intervention for nursing and midwifery education was supporting the learning experience with complementary therapies to improve participants' wellbeing and reduce stress. PMID:21724307
Broyles, Lauren M; Gordon, Adam J; Rodriguez, Keri L; Hanusa, Barbara H; Kengor, Caroline; Kraemer, Kevin L
Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.
The intraprofessional discourse about economical aspects in nursing from an ethical point of view has not taken place yet. To cope with the increasing restriction of resources, some preconditions have to be met: It is necessary to communicate issues in rationalizing and rationing in nursing openly. Person-oriented criteria in the nursing process indicate a high level of competence and user-oriented quality in nursing care. But nursing professionals do not decide in favor or against resources to perform this task on a high or poor quality level. Democratic decision-making on providing nursing services depends on a continuous societal discourse about allocation criteria.
Flória-Santos, Milena; Ramos, Ester Silveira
Biologic and technologic advances generated from The Human Genome Project are having a dramatic impact on the expanding role of nurses in current health care practice. New genetic research needs to be transformed rapidly into clinical protocols with recommendations for delivering care to targeted populations. Nurses can contribute significantly, as part of an interdisciplinary approach, to translate genome-based knowledge into benefits for health care and society. In this context, we describe a clinical-genetic investigation protocol, as well nursing diagnosis, interventions and outcomes for clients with Turner Syndrome (TS) at risk for develop gonadal tumors, due the presence of a normal or abnormal Y chromosome.
Background The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design The study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients’ health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions By helping patients to overcome practical, social and cultural obstacles and increase
What Works Clearinghouse, 2013
The "Sheltered Instruction Observation Protocol"[R] ("SIOP"[R]) is a framework for planning and delivering instruction in content areas such as science, history, and mathematics to English language learners as well as other students. The goal of "SIOP"[R] is to help teachers integrate academic language development into their lessons, allowing…
Background Quality improvement (QI) methods are widely used in surgery in an effort to improve care, often using techniques such as Plan-Do-Study-Act cycles to implement specific interventions. Explicit definition of both the QI method and quality intervention is necessary to enable the accurate replication of effective interventions in practice, facilitate cumulative learning, reduce research waste and optimise benefits to patients. This systematic review aims to assess quality of reporting of QI methods and quality interventions in perioperative care. Methods Studies reporting on quality interventions implemented in perioperative care settings will be identified. Searches will be conducted in the Ovid SP version of Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organisation of Care database and the related articles function of PubMed. The journal BMJ Quality will be searched separately. Search strategy terms will relate to (i) surgery, (ii) QI and (iii) evaluation methods. Explicit exclusion and inclusion criteria will be applied. Data from studies will be extracted using a data extraction form. The Template for Intervention Description and Replication (TIDieR) checklist will be used to evaluate quality of reporting, together with additional items aimed at assessing QI methods specifically. Systematic review registration PROSPERO http://CRD42014012845 PMID:25193066
Background The current academic literature suggests there is a potential for using gardening as a tool to improve children’s fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT) devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS) Campaign for School Gardening, to determine if it has an effect on children’s fruit and vegetable intake. Method/Design Trial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as “Partner Schools” and the other to receive the less intensive intervention as “Associate Schools”. Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention “Associate Schools” or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET) to collect data on dietary intake and a questionnaire exploring children’s knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school’s gardening activities. Discussion The results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children’s fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children’s diets and school based interventions. Trial registration ISRCTN11396528 PMID:22537179
Abdel-Aal, Ahmed K.; Dybbro, Paul; Hathaway, Peter; Guest, Steven; Neuwirth, Michael; Krishnamurthy, Venkat
Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters. PMID:24584622
For pediatric nurses, their competence in EBP is critical for providing high-quality care and maximizing patient outcomes. The purpose of this pilot study was to assess and refine a Web-based EBP educational intervention focused on improving EBP beliefs and competence in BSN-prepared pediatric bedside nurses, and to examine the feasibility,…
Park, Tanya; Usher, Kim; Foster, Kim
This paper discusses the challenges encountered by researchers while conducting a randomized controlled trial (RCT) testing the efficacy of a healthy lifestyle educational and exercise intervention for people with serious mental illness. RCTs, even though considered the “gold standard” of research designs, are still prone to risks of potential bias and threats to their validity. Based on researcher reflexivity, the combination of reflection and action, during the conduct of the study, this paper outlines a number of challenges faced by the researchers. These included managing the need of participants to tell their story and be heard, reluctance of participants to remain in allocated groups, participant literacy, dual role of the nurse nurse-researcher, and reporting the benefits of nonstatistical results of a quantitative research project. Recommendations for conducting future behaviour intervention studies of this type include the incorporation of a reflexive component for the nurse nurse-researcher, highlighting the importance of taking a reflexive stance in both qualitative and quantitative research designs. PMID:24876952
Hoeffer, Beverly; Talerico, Karen Amann; Rasin, Joyce; Mitchell, C. Madeline; Stewart, Babara J.; McKenzie, Darlene; Barrick, Ann Louise; Rader, Joanne; Sloane, Philip D.
Purpose: When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the…
Divakaran, Minoo; Babu, K Nirmal; Peter, K V
Vanilla (Vanilla planifolia Andrews (syn. V. fragrans Salisb.), a native of Central America, is the primary source of natural vanillin and plays a major role in the global economy. The gene pool of vanilla is threatened by deforestation and overcollection that has resulted in disappearance of natural habitats and wild species. Continuous vegetative propagation and lack of natural seed set and sufficient variations in the gene pool hamper crop improvement programs. In vitro techniques, one of the key tools of plant biotechnology, can be employed for overcoming specific problems, viz. production of disease-free clones, inducing somaclonal variations, developing hybrids, gene pool conservation, incorporating desired traits by distant hybridization, genetic engineering, etc. However, realization of these objectives necessitates standardization of protocols. This chapter describes the various protocols optimized for crop improvement in Vanilla species. PMID:27108309
Divakaran, Minoo; Babu, K Nirmal; Peter, K V
Vanilla (Vanilla planifolia Andrews (syn. V. fragrans Salisb.), a native of Central America, is the primary source of natural vanillin and plays a major role in the global economy. The gene pool of vanilla is threatened by deforestation and overcollection that has resulted in disappearance of natural habitats and wild species. Continuous vegetative propagation and lack of natural seed set and sufficient variations in the gene pool hamper crop improvement programs. In vitro techniques, one of the key tools of plant biotechnology, can be employed for overcoming specific problems, viz. production of disease-free clones, inducing somaclonal variations, developing hybrids, gene pool conservation, incorporating desired traits by distant hybridization, genetic engineering, etc. However, realization of these objectives necessitates standardization of protocols. This chapter describes the various protocols optimized for crop improvement in Vanilla species.
Background Despite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver. Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life. Methods/design Design: Controlled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT). Study area: Primary Health Care network (9 PHCTs). Study participants: Primary informal caregivers of patients receiving home health care from participating PHCTs. Sample: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group. Intervention: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support. Control: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request. Data analysis Dependent variables: Caregiver burden (short-form Zarit test), caregivers’ social support (Medical Outcomes Study), and
Azzolin, Karina de Oliveira; Lemos, Dayanna Machado; Lucena, Amália de Fátima; Rabelo-Silva, Eneida Rejane
OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. PMID:25806630
Cragun, Deborah L; Couch, Sarah C; Prows, Cynthia A; Warren, Nancy S; Christianson, Carol A
Allied health care professionals and nurses provide genetic-related client services, such as eliciting family medical history information and discussing the genetic component of health conditions. However, these professionals report a lack of confidence in their ability to perform genetic services and have little formal education in genetics. A barrier to incorporating genetics into allied health curricula includes the limited flexibility to expand curricula. This barrier was addressed by incorporating a Web-based tutorial on basic genetics and a lecture on the genetics of diabetes into preexisting undergraduate nutrition courses for nursing and dietetic students. The vast majority of students enrolled in these required courses participated in the intervention. Most participants agreed that genetics is important to their future career. Following the intervention, students' knowledge of genetics and confidence in their ability to provide genetic-related services increased significantly. Despite the short-term success and positive student evaluations, a single educational intervention does not appear to be sufficient for students to become proficient in performing the recommended genetic competencies for all health care professionals. Recommendations and resources for incorporating genetics into allied health curricula are included.
Castle, Nicholas; Handler, Steven; Wagner, Laura
Information from nurse aides describing their opinions of hand hygiene practices in nursing homes including perceived barriers to hand hygiene is presented. The information comes from a questionnaire developed for this investigation, with items addressing compliance, facility guidelines and protocols, training, hand washing facilities and materials, and hand washing barriers. Information from 4,211 nurse aides (response rate of 56%) working in a nationally representative sample of 767 nursing homes (participation rate = 51%) is used. We find that 57.4% of nurse aides comply with hand washing when caring for residents most of the time, while 21.7% always comply. With facilities, 43.3% sometimes check that hand washing is performed. In summary, self-reported compliance was poor, and facilities and materials were often lacking. These findings are useful in identifying issues and interventions, including the need for further initiatives to address hand hygiene practices.
Bigbee, Jeri L; Issel, L Michele
The conceptual basis of public health nursing (PHN) has evolved particularly over the past three decades. In October 2010, a national research agenda setting conference was held with grant support from the Agency for Healthcare Research and Quality. From the conference, public health nursing intervention models emerged as one of four top priorities. The need for a stronger theoretic base that can guide population-focused nursing practice and research was strongly emphasized. The purpose of this review, in concert with this priority, is to analyze the current status of PHN conceptual models. Based on the review, a set of recommendations is presented related to future conceptual development and testing, with an emphasis on PHN interventions and outcomes. A key recommendation is the refinement of the existing conceptual models with perhaps some consolidation of models, thereby establishing strong grand, middle-range and practice theories that include explicit PHN intervention and outcome components. Another recommendation calls for rigorous comparative analysis and testing. Professional support from the PHN community along with funding agencies will be needed to implement the recommendations related to PHN theory development and testing.
Braxter, Betty J; Puskar, Kathy; Mitchell, Ann M; Hagle, Holly; Gotham, Heather; Terry, Martha Ann
Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings.
Bigbee, Jeri L; Issel, L Michele
The conceptual basis of public health nursing (PHN) has evolved particularly over the past three decades. In October 2010, a national research agenda setting conference was held with grant support from the Agency for Healthcare Research and Quality. From the conference, public health nursing intervention models emerged as one of four top priorities. The need for a stronger theoretic base that can guide population-focused nursing practice and research was strongly emphasized. The purpose of this review, in concert with this priority, is to analyze the current status of PHN conceptual models. Based on the review, a set of recommendations is presented related to future conceptual development and testing, with an emphasis on PHN interventions and outcomes. A key recommendation is the refinement of the existing conceptual models with perhaps some consolidation of models, thereby establishing strong grand, middle-range and practice theories that include explicit PHN intervention and outcome components. Another recommendation calls for rigorous comparative analysis and testing. Professional support from the PHN community along with funding agencies will be needed to implement the recommendations related to PHN theory development and testing. PMID:22765249
Background The stress that results from preterm birth, requisite acute care and prolonged physical separation in the Neonatal Intensive Care Unit (NICU) can have adverse physiological/psychological effects on both the infant and the mother. In particular, the experience compromises the establishment and maintenance of optimal mother-infant relationship, the subsequent development of the infant, and the mother's emotional well-being. These findings highlight the importance of investigating early interventions that are designed to overcome or reduce the effects of these environmental insults and challenges. Methods This study is a randomized controlled trial (RCT) with blinded assessment comparing Standard Care (SC) with a novel Family Nurture Intervention (FNI). FNI targets preterm infants born 26-34 weeks postmenstrual age (PMA) and their mothers in the NICU. The intervention incorporates elements of mother-infant interventions with known efficacy and organizes them under a new theoretical context referred to collectively as calming activities. This intervention is facilitated by specially trained Nurture Specialists in three ways: 1) In the isolette through calming interactions between mother and infant via odor exchange, firm sustained touch and vocal soothing, and eye contact; 2) Outside the isolette during holding and feeding via the Calming Cycle; and 3) through family sessions designed to engage help and support the mother. In concert with infant neurobehavioral and physiological assessments from birth through 24 months corrected age (CA), maternal assessments are made using standard tools including anxiety, depression, attachment, support systems, temperament as well as physiological stress parameters. Quality of mother-infant interaction is also assessed. Our projected enrolment is 260 families (130 per group). Discussion The FNI is designed to increase biologically important activities and behaviors that enhance maternally-mediated sensory experiences of
Schou, S; Christensen, J; Hintze, H; Wenzel, A
Objectives: To perform an audit of a three-step protocol for radiographic examination of mandibular third molars before surgery. Methods: 1769 teeth underwent surgery. A standardized three-step radiographic protocol was followed: (1) panoramic imaging (PAN), (2) stereoscanography (SCAN) and (3) CBCT. If there was overprojection between the tooth and the canal in PAN, SCAN was performed. If the tooth was determined to be in close contact with the canal in SCAN, CBCT was performed. Close contact between the tooth and the canal was assessed in all images, and patient-reported sensory disturbances from the alveolar inferior nerve were recorded after surgery. The relation between the final radiographic examination and sensory disturbances was determined. Logistic regression analysis tested whether signs for a close contact in PAN/SCAN could predict no bony separation between the tooth and canal in CBCT. Results: 46% of teeth underwent PAN, 31% underwent SCAN and 23% underwent CBCT as the final examination. 21% underwent all three radiographic examinations. 53/76% of teeth with close relation to the canal in PAN/SCAN showed no bony separation in CBCT; if there was close relation in PAN/SCAN, there was 1.6/4.3 times higher probability that no bony separation existed in CBCT. 16 cases of sensory disturbances were recorded: 4 operations were based on PAN, 8 on SCAN and 4 on CBCT. Conclusions: The radiographic protocol was in general followed. SCAN was superior to PAN in predicting no bony separation between the tooth and the canal in CBCT, and there was no relation between sensory disturbances and radiographic method. PMID:25216077
Low, Lee-Fay; Fletcher, Jennifer; Goodenough, Belinda; Jeon, Yun-Hee; Etherton-Beer, Christopher; MacAndrew, Margaret; Beattie, Elizabeth
Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex
Background Arts-based activities are being increasingly suggested as a valuable activity for people living with dementia in terms of countering the negative aspects of their condition. The potential for such programmes to improve a broad range of psychosocial outcomes is suggested in some studies. However, there is largely an absence of rigorous methodology to demonstrate the benefits, and research results are mixed. Practice variability in terms of the content, contexts and implementation of such interventions raises challenges in terms of identifying an optimal arts programme model that could be adopted by other service providers. Understanding how interventions may have the best chance at broad implementation success and uptake is limited. Methods/Design A realist review will be undertaken. This aims to understand how visual arts interventions influence outcomes in people living with dementia. The review will explore how the context, that is the circumstances which enable or constrain, affect outcomes through the activation of mechanisms. An early scoping search and a stakeholder survey formulated the preliminary programme theory. A systematic literature search across a broad range of disciplines (arts, humanities, social sciences, health) will be undertaken to identify journal articles and grey literature. Data will be extracted in relation to the programme theory, contextual factors, mechanisms and outcomes and their configurations, background information about the study design and participant characteristics, detail about the quantity (‘dose’) of an intervention, theoretical perspectives proposed by the authors of the paper and further theorising by the reviewer. Thematic connections/patterns will be sought across the extracted data, identifying patterns amongst contextual factors, the mechanisms they trigger and the associated outcomes. Discussion Along with stakeholder engagement and validation, this review will help inform the development of an optimal
Background Obesity affects 25% of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease. Some effective weight loss treatments exist but there is no nationally available National Health Service (NHS) treatment service, and general practitioners (GPs) rarely discuss weight management with patients or support behavior change. Evidence shows that commercial weight management services, that most primary care trusts have 'on prescription', are more effective than primary care treatment. Methods/design We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress, or advice to lose weight on medical grounds. The primary outcome will be weight change at 12-months. Other questions are: what actions do people take to manage their weight in response to the two GP intervention types? How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type? How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention? What is the cost per kg/m2 lost for each intervention? Research assistants visiting GP practices in England (n = 60) would objectively measure weight and height prior to GP consultations and randomize willing patients (body mass index 30+, excess body fat, 18+ years) using sealed envelopes. Full recruitment (n = 1824) is feasible in 46 weeks, requiring six sessions of advice-giving per GP. Participants will be contacted at 3 months (postintervention) via telephone to identify actions they have taken to manage their weight. We will book appointments for participants to be seen at their GP practice for a 12-month follow-up. Discussion Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop
Bidargaddi, Niranjan; Blake, Victoria; Schrader, Geoffrey; Kaambwa, Billingsley; Quinn, Stephen; Orlowski, Simone; Winsall, Megan; Battersby, Malcolm
Background Research has shown that improving well-being using positive mental health interventions can be useful for predicting and preventing mental illness. Implementing online interventions may be an effective way to reach young people, given their familiarity with technology. Objective This study will assess the effectiveness of a website called the “Online Wellbeing Centre (OWC),” designed for the support and improvement of mental health and well-being in young Australians aged between 16 and 25 years. As the active component of the study, the OWC will introduce a self-guided app recommendation service called “The Toolbox: The best apps for your brain and body” developed by ReachOut.com. The Toolbox is a responsive website that serves as a personalized, ongoing recommendation service for technology-based tools and apps to improve well-being. It allows users to personalize their experience according to their individual needs. Methods This study will be a two-arm, randomized controlled trial following a wait-list control design. The primary outcome will be changes in psychological well-being measured by the Mental Health Continuum Short Form. The secondary outcomes will be drawn from a subsample of participants and will include depression scores measured by the Center for Epidemiologic Studies Depression Scale, and quality of life measured by the Assessment of Quality of Life-four dimensions (AQOL-4D) index. Cost-effectiveness analysis will be conducted based on a primary outcome of cost per unique visit to the OWC. Utility-based outcomes will also be incorporated into the analysis allowing a secondary outcome to be cost per quality-adjusted life year gained (based on the AQOL-4D values). Resource use associated with both the intervention and control groups will be collected using a customized questionnaire. Online- and community-based recruitment strategies will be implemented, and the effectiveness of each approach will be analyzed. Participants will
Background The epidemic of Alzheimer's disease (AD) represents a significant challenge for the health care and social service systems of many developed countries. AD affects both patients and family caregivers, on whom the main burden of care falls, putting them at higher risk of stress, anxiety, mortality and lower quality of life. Evidence remains controversial concerning the effectiveness of providing support to caregivers of AD patients, through case management, counseling, training, technological devices and the integration of existing care services. The main objectives of the UP-TECH project are: 1) to reduce the care burden of family caregivers of AD patients; and 2) to maintain AD patients at home. Methods/design A total of 450 dyads comprising AD patients and their caregivers in five health districts of the Marche region, Italy, will be randomized into three study arms. Participants in the first study arm will receive comprehensive care and support from a case manager (an ad hoc trained social worker) (UP group). Subjects in the second study arm will be similarly supported by a case manager, but in addition will receive a technological toolkit (UP-TECH group). Participants in the control arm will only receive brochures regarding available services. All subjects will be visited at home by a trained nurse who will assess them using a standardized questionnaire at enrollment (M0), 6 months (M6) and 12 months (M12). Follow-up telephone interviews are scheduled at 24 months (M24). The primary outcomes are: 1) caregiver burden, measured using the Caregiver Burden Inventory (CBI); and 2) the actual number of days spent at home during the study period, defined as the number of days free from institutionalizations, hospitalizations and stays in an observation unit of an emergency room. Discussion The UP-TECH project protocol integrates previous evidence on the effectiveness of strategies in dementia care, that is, the use of case management, new technologies, nurse
Moazzami, Zeinab; Dehdari, Tahere; Taghdisi, Mohammad Hosein; Soltanian, Alireza
Background: One of the preventive strategies for chronic low back pain among operating room nurses is instructing proper body mechanics and postural behavior, for which the use of the Transtheoretical Model (TTM) has been recommended. Methods: Eighty two nurses who were in the contemplation and preparation stages for adopting correct body posture were randomly selected (control group = 40, intervention group = 42). TTM variables and body posture were measured at baseline and again after 1 and 6 months after the intervention. A four-week ergonomics educational intervention based on TTM variables was designed and conducted for the nurses in the intervention group. Results: Following the intervention, a higher proportion of nurses in the intervention group moved into the action stage (p < 0.05). Mean scores of self-efficacy, pros, experimental processes and correct body posture were also significantly higher in the intervention group (p < 0.05). No significant differences were found in the cons and behavioral processes, except for self-liberation, between the two groups (p > 0.05) after the intervention. Conclusions: The TTM provides a suitable framework for developing stage-based ergonomics interventions for postural behavior. PMID:26925897
Background Depression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients. Interventions feasible for use in primary care are needed to improve both mood and cardiac outcomes. The UPBEAT-UK programme of research has been funded by the NHS National Institute for Health Research (NIHR) to explore the relationship between CHD and depression and to develop a new intervention for use in primary care. Methods Using the Medical Research Council (MRC) guidelines for developing and evaluating complex interventions, we conducted a systematic review and qualitative research to develop a primary care-based nurse-led intervention to improve mood and cardiac outcomes in patients with CHD and depression. Iterative literature review was used to synthesise our empirical work and to identify evidence and theory to inform the intervention. Results We developed a primary care-based nurse-led personalised care intervention which utilises elements of case management to promote self management. Following biopsychosocial assessment, a personalised care plan is devised. Nurses trained in behaviour change techniques facilitate patients to address the problems important to them. Identification and utilisation of existing resources is promoted. Nurse time is conserved through telephone follow up. Conclusions Application of the MRC framework for complex interventions has allowed us to develop an evidence based intervention informed by patient and clinician preferences and established theory. The feasibility and acceptability of this intervention is now being tested further in an exploratory trial. PMID:23234253
Okolie, Chukwudi; Evans, Bridie Angela; John, Ann; Moore, Chris; Russell, Daphne; Snooks, Helen
Introduction Drug overdose is the most frequent cause of death among people who misuse illegal drugs. People who inject these drugs are 14–17 times more likely to die than their non-drug using peers. Various strategies to reduce drug-related deaths have failed to meet target reductions. Research into community-based interventions for preventing drug overdose deaths is promising. This review seeks to identify published studies describing community-based interventions and to evaluate their effectiveness at reducing drug overdose deaths. Methods and analysis We will systematically search key electronic databases using a search strategy which groups terms into four facets: (1) Overdose event, (2) Drug classification, (3) Intervention and (4) Setting. Searches will be limited where possible to international literature published in English between 1998 and 2014. Data will be extracted by two independent reviewers using a predefined table adapted from the Cochrane Collaboration handbook. The quality of included studies will be evaluated using the Cochrane Collaboration's tool for assessing risk of bias. We will conduct a meta-analysis for variables which can be compared across studies, using statistical methods to control for heterogeneity where appropriate. Where clinical or statistical heterogeneity prevents a valid numerical synthesis, we will employ a narrative synthesis to describe community-based interventions, their delivery and use and how effectively they prevent fatal overdoses. Ethics and dissemination We will publish findings from this systematic review in a peer-reviewed scientific journal and present results at national and international conferences. It will be disseminated electronically and in print. Trial registration number PROSPERO CRD42015017833. PMID:26534734
Introduction Governments in different countries have committed to better use of evidence from research in policy. Although many programmes are directed at assisting agencies to better use research, there have been few tests of the effectiveness of such programmes. This paper describes the protocol for SPIRIT (Supporting Policy In health with Research: an Intervention Trial), a trial designed to test the effectiveness of a multifaceted programme to build organisational capacity for the use of research evidence in policy and programme development. The primary aim is to determine whether SPIRIT results in an increase in the extent to which research and research expertise is sought, appraised, generated and used in the development of specific policy products produced by health policy agencies. Methods and analysis A stepped wedge cluster randomised trial involving six health policy agencies located in Sydney, Australia. Policy agencies are the unit of randomisation and intervention. Agencies were randomly allocated to one of three start dates (steps) to receive the 1-year intervention programme, underpinned by an action framework. The SPIRIT intervention is tailored to suit the interests and needs of each agency and includes audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to assist in the use of research in policies; and exchange with researchers. Outcome measures will be collected at each agency every 6 months for 30 months (starting at the beginning of step 1). Ethics and dissemination Ethics approval was granted by the University of Western Sydney Human Research and Ethics Committee HREC Approval H8855. The findings of this study will be disseminated broadly through peer-reviewed publications and presentations at conferences and used to inform future strategies. PMID:24989620
Droes, N S; Hatton, D C; Kramer, M
In this pretest, posttest, control group study, high school biology students (N = 451) were actively engaged in a dialogue with an investigator/change agent regarding specific nursing situations in which the image dimensions of caring, useful, scientifically knowledgeable, and autonomous were highlighted. The effects of this involvement and participation on students' image and valuation of nursing were assessed. The process was found to be highly effective in expanding students' image of nursing and moderately effective in increasing their valuation of nursing. PMID:8421128
Hadorn, Fabienne; Comte, Pascal; Foucault, Eliane; Morin, Diane; Hugli, Olivier
It has been shown that over 70% of patients waiting in emergency departments (EDs) do not receive analgesics, despite the fact that more than 78% complain of pain. A clinical innovation in the form of a pain management protocol that includes task-shifting has been implemented in the ED of a university hospital in Switzerland in order to improve pain-related outcomes in patients. This innovation involves a change in clinical practice for physicians and nurses. The aim of this study is to explore nurses' perceptions on how well this innovation is adopted. This descriptive correlational study took place in the ED of a Swiss university hospital; the hospital provides healthcare for the city, the canton, and adjoining cantons. A convenience sample of 37 ED nurses participated. They were asked to complete a questionnaire comprising 56 statements based on Rogers's "Diffusion of Innovation" theory. Nurses' opinions (on a 1-10 Likert scale) indicate that the new protocol benefits the ED (mean [M] = 7.4, standard deviation [SD] = 1.21), is compatible with nursing roles (M = 8.0, SD = 1.9), is not too complicated to apply (M = 2.7, SD = 1.7), provides observable positive effects in patients (M = 7.0, SD = 1.28), and is relatively easy to introduce into daily practice (M = 6.5, SD = 1.0). Further studies are now needed to examine patients' experiences of this innovation.
Miller, Louise C; Russell, Cynthia L; Cheng, An-Lin; Skarbek, Anita J
While professional nurses are expected to communicate clearly, these skills are often not explicitly taught in undergraduate nursing education. In this research study, writing self-efficacy and writing competency were evaluated in 52 nontraditional undergraduate baccalaureate completion students in two distance-mediated 16-week capstone courses. The intervention group (n = 44) experienced various genres and modalities of written assignments set in the context of evidence-based nursing practice; the comparison group (n = 8) received usual writing undergraduate curriculum instruction. Self-efficacy, measured by the Post Secondary Writerly Self-Efficacy Scale, indicated significant improvements for all self-efficacy items (all p's = 0.00). Writing competency, assessed in the intervention group using a primary trait scoring rubric (6 + 1 Trait Writing Model(®) of Instruction and Assessment), found significant differences in competency improvement on five of seven items. This pilot study demonstrated writing skills can improve in nontraditional undergraduate students with guided instruction. Further investigation with larger, culturally diverse samples is indicated to validate these results.
Background Smoking during pregnancy and in the postnatal period is a major cause of low birth weight and a range of adverse infant health outcomes. Stop smoking services can double quit rates, but only 17% of pregnant women smoking at the time they book for antenatal care use these services. In a recent Cochrane review on the effectiveness of smoking cessation interventions in pregnancy, financial incentives were found to be the single most effective intervention. We describe a single arm intervention study offering participation in a financial incentive scheme for smoking cessation to all pregnant smokers receiving antenatal care in one area in England. The aim of the study is to assess the potential effectiveness of using financial incentives to achieve smoking cessation in pregnant women who smoke, to inform the use of financial incentive schemes in routine clinical practice as well as the interpretation of existing trials and the design of future studies. Method/design 500 consecutive pregnant smokers are offered participation in the scheme, which involves attending for up to 32 assessments until six months post-partum, to verify smoking cessation by self report and a negative exhaled carbon monoxide measurement. At each visit when cessation is verified, participants receive a shopping voucher starting at a value of £8 and increasing by £1 at each consecutive successful visit. Assessments decline in frequency, occurring most frequently during the first two weeks after quitting and the first two weeks after delivery. The maximum cumulative total that can be earned through the scheme is £752. Discussion The results of this study will inform the use of financial incentive schemes in routine clinical practice as well as the interpretation of existing trials and the design of future studies. The main results are (a) an estimate of the proportion of pregnant smokers who enrol in the scheme; (b) estimates of the proportion of pregnant smokers who participate in the
Background There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these domains in a number of other clinical disorders. Furthermore, neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes. The current manuscript presents the rationale, design considerations, and study design of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study. Methods/Design STRIDE is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. This study will evaluate individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. Three hundred and thirty eligible and interested participants who provide informed consent will be randomized to one of two treatment arms: Vigorous Intensity High Dose Exercise Augmentation (DEI) or Health Education Intervention Augmentation (HEI). Both groups will receive TAU (i.e., usual care). The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants will begin with supervised sessions 3 times per week during the 12-week acute phase of the study. Supervised sessions will be conducted as one-on-one (i.e., individual) sessions, although other
Artinian, Nancy T; Schwiebert, Loren; Yarandi, Hossein; Levy, Phillip D
Background Hypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population. Objective The purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN. Methods In Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention. Results Although data collection is now complete, data analysis from the
Rasmussen, Charlotte Diana Nørregaard; Holtermann, Andreas; Bay, Hans; Søgaard, Karen; Birk Jørgensen, Marie
This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) for low back pain (LBP). Between November 2012 and May 2014, we conducted a pragmatic stepped wedge cluster randomised controlled trial with 594 workers from eldercare workplaces (nursing homes and home care) randomised to 4 successive time periods, 3 months apart. The intervention lasted 12 weeks and consisted of 19 sessions in total (physical training [12 sessions], CBT [2 sessions], and participatory ergonomics [5 sessions]). Low back pain was the outcome and was measured as days, intensity (worst pain on a 0-10 numeric rank scale), and bothersomeness (days) by monthly text messages. Linear mixed models were used to estimate the intervention effect. Analyses were performed according to intention to treat, including all eligible randomised participants, and were adjusted for baseline values of the outcome. The linear mixed models yielded significant effects on LBP days of -0.8 (95% confidence interval [CI], -1.19 to -0.38), LBP intensity of -0.4 (95% CI, -0.60 to -0.26), and bothersomeness days of -0.5 (95% CI, -0.85 to -0.13) after the intervention compared with the control group. This study shows that a multifaceted intervention consisting of participatory ergonomics, physical training, and CBT can reduce LBP among workers in eldercare. Thus, multifaceted interventions may be relevant for improving LBP in a working population.
Ross, Erin L.; Bell, Sue E.
Context: One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. Purpose: The purpose of this study was to determine the influence of registered nurses' certifications…
Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter
Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…
Jameson, Paula R.
Despite the known benefits of hardiness education, no published research has been found on the effects of hardiness education with nursing students. Thus, the purposes of this study were first to determine if an increase in hardiness and a decrease in perceived stress in baccalaureate nursing students occurred in those who participated in a…
Morrison-Beedy, D; Aronowitz, T; Dyne, J; Mkandawire, L; Murphy, C; Martin, J
One of the most critical phases involved in carrying out a research project is participant recruitment. Recruitment into clinical trials and health programs is a primary public health challenge, particularly among adolescents. Special skills and abilities are needed to successfully recruit participants from this developmental age group. This paper describes the similarities found between the recruitment process developed for a randomized controlled trial with adolescents and the steps of the nursing process, and demonstrates that knowledge of the nursing process can assist in successfully recruiting individuals for a research study. Even without research training, clinical nurses can play a significant role in research studies because of their skills and experiences with the nursing process. Thus, nurse scientists and clinicians can work together successfully to conduct research studies and health projects that involve challenging recruitment efforts. PMID:16052902
Tan, Rhigel Alforque; Alpert, Patricia T
Increasingly, the U.S. health care system relies on internationally educated nurses to meet the staffing shortage. Many of these nurses come to the United States from Asian countries, especially the Philippines, India, Korea, and increasingly China. Because of conflicting professional and socioeconomic expectations, a growing body of literature has documented a range of challenges experienced by internationally educated nurses during their transition to the U.S. health care environment and American society. This article describes an increase in perceived self-efficacy for a group of internationally educated nurses (N = 18) who participated in an adverse cardiac event with the use of computer-assisted simulation training. The findings indicate that internationally educated nurses may increase their self-efficacy in caring for patients in U.S. health care facilities if they receive some pre-employment simulation training to help them transition to the U.S. health care work force.
This Best Practice Information Sheet updates and supersedes an earlier publication of the Joanna Briggs Institute in 2005. The information that is contained in this publication is based upon a systematic review of six randomized clinical trials. Additional information has been derived from a second systematic review; thus, in total, the information is derived from 22 randomized controlled trials. The original references can be sourced from the systematic reviews. Coronary heart disease (CHD) is the major cause of illness in Western society and it is becoming increasingly important to establish effective strategies in order to reduce the incidence of CHD. Nurse-led clinics are becoming more prominent in community settings and the importance of nurse interventions in the management of CHD and risk factor reduction is recognized in terms of improved health outcomes for patients. However, the variation in outcome measures and inconsistent findings between some studies make it difficult to draw firm conclusions. PMID:20727078
Rassouli, Maryam; Zamanzadeh, Vahid; Ghahramanian, Akram; Abbaszadeh, Abbas; Alavi-Majd, Hamid; Nikanfar, Alireza
Background: Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses’ and patients’ experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purposive sampling by conducting unstructured interviews with 10 patients and 7 nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: Three categories emerged from the study: (1) “perceived barriers for providing spiritual care” including “lack of preparation for spiritual care,” “time and space constraints,” “unprofessional view,” and “lack of support”; (2) “communication: A way for Strengthening spirituality despite the limitations” including “manifestation of spirituality in the appearances and communicative behaviors of nurses” and “communication: Transmission of spiritual energy”; and (3) “religion-related spiritual experiences” including “life events as divine will and divine exam,” “death as reincarnation,” “trust in God,” “prayer/recourse to Holy Imams,” and “acceptance of divine providence.” Although nurses had little skills in assessing and responding to the patients’ spiritual needs and did not have the organizational and clergymen's support in dealing with the spiritual distress of patients, they were the source of energy, joy, hope, and power for patients by showing empathy and compassion. The patients and nurses were using religious beliefs mentioned in Islam to strengthen the patients’ spiritual dimension. Conclusions: According to the results, integration of spiritual care in the curriculum of nursing is recommended. Patients and
Carlisle, Karen; Warren, Robin; Scuffham, Paul; Cheffins, Tracy
Type 2 diabetes is a leading cause of death and morbidity and is a health priority in Australia. This randomised controlled trial will explore whether remote access to clinical care, supported by telehealth technologies over high speed broadband, leads to improved diabetes control in a way that benefits patients, carers and clinicians and improves the overall health system. People in the intervention arm of the trial will receive additional diabetes care from a care coordinator nurse via an in-home broadband communication device that can capture clinical measures, provide regular health assessments and videoconference with other health professionals when required. Patients in the control arm of the trial will receive usual care from their GP and participate in the clinical measurement and quality of life components of the evaluation. The trial evaluation will include biomedical, psychological, self-management and quality of life measures. Data on utilisation rates and satisfaction with the technology will be collected and cost -effectiveness analyses undertaken. The role of this technology in health care reform will be explored. PMID:23138078
Appel, Caroline; Perry, Lin; Jones, Fiona
This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention. PMID:25664993
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion
Background India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at ‘high risk’ of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. Methods/design A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30–60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education
Background Globally, the incidence of sexually transmitted infections (STI) is rising, posing a challenge to its control and appropriate management. Text messaging has become the most common mode of communication among almost six billion mobile phone users worldwide. Text messaging can be used to remind patients about clinic appointments, to notify patients that it is time for STI re-testing, and to facilitate patient communication with their health professionals with any questions and concerns they may have about their sexual health. While there are a handful of systematic reviews published on short message service (SMS) interventions in a variety of health settings and issues, none are related to sexual health. We plan to conduct a systematic review to examine the impact text messaging might have on interventions for the prevention and care of patients with STIs. Methods/Design Eligible studies will include both quantitative and qualitative studies published after 1995 that discuss the efficacy and effectiveness of SMS interventions for STI prevention and management using text messaging. Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Inter-rater reliability scores will be obtained to ensure consistency in the inclusion and data extraction of studies. Heterogeneity will be assessed using the I2 test and subgroup analyses. A nonhypothesis driven inductive reasoning approach as well as a coding framework will be applied to analyze qualitative studies. A meta-analysis may be conducted if sufficient quantitative studies are found using similar outcomes. Discussion For this protocol, we identified ten related systematic reviews. The reviews were limited to a particular disease or setting, were not exclusive to SMS interventions, or were out of date. This systematic review will be the first comprehensive examination of studies that discuss the effectiveness of SMS on multiple outcomes that relate to STI
Hofmeyer, Anne; Toffoli, Luisa; Vernon, Rachael; Taylor, Ruth; Fontaine, Dorrie; Klopper, Hester C.; Coetzee, Siedine Knobloch
Background: There is an increasing global demand for higher education to incorporate flexible delivery. Nursing education has been at the forefront of developing flexible online education and offering programs "anywhere and anytime". In response to calls to teach compassion in nursing education, there is an abundance of literature…
Nilsson, U B; Willman, A
In this article we describe the results of a comparative study focusing on the evaluation of nursing documentation before and after an educational intervention. An additional aim is to report the results of a comparison between quality measurements of nursing documentation using the examination instruments NoGA and Cat-ch-ing and, against this background, to recommend an instrument for future examinations. The educational intervention was directed towards nurses at Helsingborg hospital/health care district. The intervention, which comprised supervision, group sessions, lectures and field trips, covered a period of two years and was built on a learning model. In all, the data material examined included 515 nursing records collected from 52 units. The study reports on a comparison of the examination results from four different clinics for the years 1994 and 1997. The results show a statistically significant difference between the four clinics before the intervention, a difference that disappeared after the intervention. Furthermore, the results show a statistically significant improvement in documentation after the intervention. For future examinations, it is recommended that the examination instrument Cat-ch-ing should be used and that methods for examination of the content of the documentation must be developed.
Thomas, Shane A; Merkouris, Stephanie S; Browning, Colette J; Radermacher, Harriet; Feldman, Susan; Enticott, Joanne; Jackson, Alun C
Introduction International prevalence rates for problem gambling are estimated at 2.3%. Problem gambling is a serious global public health concern due to adverse personal and social consequences. Previous research evaluating the effectiveness of psychological interventions for the treatment of problem gambling has been compromised by methodological limitations, including small sample sizes and the use of waitlist control groups. This article describes the study protocol for a pragmatic randomised controlled trial (RCT) evaluating the effectiveness of cognitive-behavioural therapy (CBT), behaviour therapy (BT), motivational interviewing (MI) against a non-directive supportive therapy (NDST) control, in treating problem gambling. Methods and analysis This study was a mixed-methods design, with a parallel group, pragmatic RCT as the primary component, and embedded qualitative studies conducted alongside. A total of 297 participants were recruited from the community in Victoria, Australia. Individuals aged 18 years and over, could communicate in English and wished to receive treatment for a gambling problem were eligible. Participants were randomly allocated in to 1 of the 4 psychological interventions: CBT, BT, MI and NDST. Repeated measures were conducted at pretreatment and post-treatment, and 6 and 12 months post-treatment. The statistical analysis will use an intention-to-treat approach. Multilevel mixed modelling will be used to examine changes in the primary outcome measures: gambling symptom severity, using the Gambling Symptom Assessment Scale, and gambling behaviours (frequency, time and expenditure). Secondary outcomes are depression, anxiety, stress and alcohol use. Individual semistructured qualitative interviews were conducted at pretreatment and post-treatment and 12 months post-treatment for a subset of participants (n=66). Ethics and dissemination This study was approved by the Victorian Department of Justice, Monash University and the University
Chapman, Sarah C E; Barnes, Neil; Barnes, Mari; Wilkinson, Andrea; Hartley, John; Piddock, Cher; Weinman, John; Horne, Rob
Objectives The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations. Design Pre-post intervention study. Setting Secondary care. Participants Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female). Intervention Asthma nurse specialists attended a 1.5-day NCF briefing. Primary and secondary outcome measures Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery. Results After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (p<0.05), but the intervention was not applied extensively enough to improve adherence. Conclusions The intervention changed nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations. PMID:26048207
Pridham, Karen A.; Lutz, Kristin F.; Anderson, Lori S.; Riesch, Susan K.; Becker, Patricia T.
PURPOSE This integrative review concerns nursing research on parent–child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS Observation of social–emotional as well as task-related interaction qualities in the context of assessing parent–child relationships could generate new questions for nursing research and for family-centered nursing practice. PMID:20074112
Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin
Aims Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. Methods A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. Results No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). Conclusion Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium. PMID:26034489
Chujo, Masami; Okamura, Hitoshi
Background The objective of this study was to provide cancer patients with a psychosocial group intervention consisting of 3 parts, i.e., education on how to cope with stress and solve problems, group discussions, and progressive muscle relaxation, and to investigate the intervention techniques of Japanese facilitators. Methods Group interventions for breast cancer patients performed by 3 facilitators were analyzed qualitatively and inductively using a phenomenological approach. Results The skills of facilitators included 10 intervention techniques and 1 problem in interventions. Intervention techniques, which promote group dynamics and thereby help participants acquire improvements in their coping abilities and quality of life (QOL), were somewhat different between new and experienced facilitators, with the content showing immaturity and maturity in the new and experienced facilitators, respectively. Both experienced and new facilitators faced the risk of experiencing problems in interventions, which countered the purpose of the intervention of improving the participants’ coping abilities or QOL. Conclusion While intervention skills are necessary for facilitators to execute group interventions, it must be borne in mind, that even well-experienced facilitators may not always be able to accomplish skillful intervention. PMID:26306056
O'Connor, Siobhan; Andrews, Tom
Nurse educators are exploring different mobile technologies to provide additional support to nursing students in clinical practice. However, the view of nursing students on the use of smartphone applications (apps) to enhance clinical education has not been explored. This proposed study will use a self-reported questionnaire to examine the opinions of nursing students on the current and potential use of smartphone apps when training in clinical settings. Descriptive and inferential statistics will be performed on the quantitative data. Qualitative data from open ended questions will be thematically analysed using the framework approach. This will be the first study to examine the use of smartphone apps as a support in clinical teaching from a students' perspective. Their opinion is vital if the right mobile technology is to be designed and implemented. PMID:27332464
Background Systematic reviewers may encounter a multiplicity of outcome data in the reports of randomised controlled trials included in the review (for example, multiple measurement instruments measuring the same outcome, multiple time points, and final and change from baseline values). The primary objectives of this study are to investigate in a cohort of systematic reviews of randomised controlled trials of interventions for rheumatoid arthritis, osteoarthritis, depressive disorders and anxiety disorders: (i) how often there is multiplicity of outcome data in trial reports; (ii) the association between selection of trial outcome data included in a meta-analysis and the magnitude and statistical significance of the trial result, and; (iii) the impact of the selection of outcome data on meta-analytic results. Methods/Design Forty systematic reviews (20 Cochrane, 20 non-Cochrane) of RCTs published from January 2010 to January 2012 and indexed in the Cochrane Database of Systematic Reviews (CDSR) or PubMed will be randomly sampled. The first meta-analysis of a continuous outcome within each review will be included. From each review protocol (where available) and published review we will extract information regarding which types of outcome data were eligible for inclusion in the meta-analysis (for example, measurement instruments, time points, analyses). From the trial reports we will extract all outcome data that are compatible with the meta-analysis outcome as it is defined in the review and with the outcome data eligibility criteria and hierarchies in the review protocol. The association between selection of trial outcome data included in a meta-analysis and the magnitude and statistical significance of the trial result will be investigated. We will also investigate the impact of the selected trial result on the magnitude of the resulting meta-analytic effect estimates. Discussion The strengths of this empirical study are that our objectives and methods are pre
Iverson, Carol J.; Klahn, Julie K.
The 1994 Nebraska Governor's round table subcommittee established the goal of lowering teenage pregnancies in the state by the year 2000. School nurses are in key positions to provide continuous support and surveillance of adolescent health through graduation. This publication presents guidelines and resources to encourage and assist school nurses…
Stacey, Dawn; Pomey, Marie-Pascale; O'Connor, Annette M; Graham, Ian D
Background Effective interventions prepare patients for making values-sensitive health decisions by helping them become informed and clarifying their values for each of the options. However, patient decision support interventions have not been widely implemented and little is known about effective models for delivering them to patients. The purpose of this study was to describe call centre nurses' adoption of a decision support protocol into practice following exposure to an implementation intervention and to identify factors influencing sustainable nursing practice changes. Methods Exploratory case study at a Canadian province-wide call centre guided by the Ottawa Model of Research Use. Data sources included a survey of nurses who participated in an implementation intervention (n = 31), 2 focus groups with nurses, interviews with 4 administrators, and a document review. Results Twenty-five of 31 nurses responded to the survey measuring adoption of decision support in practice. Of the 25 nurses, 11 had used the decision support protocol in their practice within one month of the intervention. Twenty-two of the 25 intended to use it within the next three months. Although some nurses found it challenging to begin using the protocol, most nurses reported that it: a) helped them recognize callers needing decision support; b) changed their approach to handling these calls; and c) was a positive enhancement to their practice. Strategies identified to promote sustainability of practice changes included integration of the decision support protocol in the call centre database, streamlining the patient decision aids for easier use via telephone, clarifying the administrative direction for the call centre's program, creating a call length guideline specific for these calls, incorporating decision support training in the staff development plan, and informing the public of this enhanced service. Conclusion Although most nurses adopted the decision support protocol for coaching
Ekama Ilesanmi, Rose; Morohunfoluwa Oluwatosin, Odunayo
Educational intervention programs are an important element to improve nurses' knowledge of pressure ulcer (PU) prevention. Various teaching methods have been used with diverse results but none have been analyzed in Nigeria. A quasi- experimental study using a pretest/post test design was conducted among 193 registered nurses with >6 months experience who worked in purposefully selected wards (neuroscience, orthopedics, renal, and cardiac) in 3 teaching hospitals to examine the level of knowledge retention after interactive instruction. Participants were randomized to intervention (IG, n = 127 from 2 hospitals) and control (CG, n = 66 from 1 hospital) groups; the IG was provided a 5-day, face-to-face interactive lecture, and the CG engaged in a 1-day, 4-hour discussion of PU prevention practices. The Pressure Ulcer Knowledge Tool, a 47-item questionnaire in which a correct answer = 1 point and an incorrect/"I don't know" answer = 0 (maximum score 47), was used to assess and compare knowledge retention at 3 time points: baseline (T1), immediately after instruction (T2), and after 3 months (T3). Three trained research assistants assisted with registration of participants and distribution and collection of the questionnaires. All questionnaires were retrieved at T1 before the intervention be- gan. Respondents were encouraged to respond to all questions. Data were analyzed using t-test and ANOVA (P = 0.05). At T1, knowledge scores were comparable between the IG and CG (32.5 ± 4.2 and 30.8 ± 5.0 for IG and CG, respectively). At T2, knowledge scores increased significantly only in the IG to 40.7 ± 3.4 (d = 1.94, P less than 0.05). The mean difference between T1 and T2 was -8.2 ± 5.4, t = -17.0, P = 0.000. Similarly, mean scores increased significantly from T2 to T3 in the IG (mean= -2.0 ± 5.5, t = -4.1, P = 0.000); scores in the CG were -6.2 ± 7.2, t = -6.3 (P = 0.000). A face-to-face interactive lecture was shown to be an effective method of program delivery for
Background Despite decades of nutrition education, the prevalence of unhealthy dietary patterns is still high and inequalities in intake between high and low socioeconomic groups still exist. Therefore, it is important to innovate and improve existing nutrition education interventions. This paper describes the development, design and evaluation protocol of a web-based computer-tailored nutrition education intervention for adults targeting fruit, vegetable, high-energy snack and fat intake. This intervention innovates existing computer-tailored interventions by not only targeting motivational factors, but also volitional and self-regulation processes and environmental-level factors. Methods/design The intervention development was guided by the Intervention Mapping protocol, ensuring a theory-informed and evidence-based intervention. Two versions of the intervention were developed: a basic version targeting knowledge, awareness, attitude, self-efficacy and volitional and self-regulation processes, and a plus version additionally addressing the home environment arrangement and the availability and price of healthy food products in supermarkets. Both versions consist of four modules: one for each dietary behavior, i.e. fruit, vegetables, high-energy snacks and fat. Based on the self-regulation phases, each module is divided into three sessions. In the first session, feedback on dietary behavior is provided to increase awareness, feedback on attitude and self-efficacy is provided and goals and action plans are stated. In the second session goal achievement is evaluated, reasons for failure are explored, coping plans are stated and goals can be adapted. In the third session, participants can again evaluate their behavioral change and tips for maintenance are provided. Both versions will be evaluated in a three-group randomized controlled trial with measurements at baseline, 1-month, 4-months and 9-months post-intervention, using online questionnaires. Both versions will
Background Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. Methods A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored
Friedman, Bruce; Wamsley, Brenda R.; Liebel, Dianne V.; Saad, Zabedah B.; Eggert, Gerald M.
Purpose: To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care-affiliated disease self-management-health promotion nurse intervention for Medicare beneficiaries with disabilities and recent significant health services use. Design and Methods: The Medicare…
Cohen-Mansfield, Jiska; Jensen, Barbara; Resnick, Barbara; Norris, Margaret
Purpose of the Study: Behavior problems are common in nursing homes. Current guidelines recommend nonpharmacological interventions (NPHIs) as first-line treatment, but pharmacological regimens (PIs) continue to be used. Given differences in background and training of those who treat behavior problems in residents, we compared attitudes of…
Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process
Background Physical inactivity is a recognized public health concern. Inadequate proportions of children in the U.S, including those of preschool age, are meeting physical activity recommendations. In response to low numbers of preschool children attaining appropriate physical activity levels, combined with the large number of young children who attend preschool, researchers have identified the need to devise interventions to increase physical activity at preschools. However, few multi-component interventions to increase physical activity in preschool children exist. The aims of this study were to observe the effects of a multi-component intervention on physical activity, sedentary behavior, and physical activity energy expenditure in 3-5 year-old children; identify factors that associate with change in those variables; and evaluate the process of implementing the multi-component intervention. The purpose of this manuscript is to describe the study design and intervention protocol. Methods/design The overall design of the Study of Health and Activity in Preschool Environments (SHAPES) was a two-year randomized trial (nested cohort design), with two conditions, two measurement occasions, and preschool serving as the unit of analysis. Sixteen schools (eight intervention and eight control) were enrolled. The intervention protocol was based on the social ecological model and included four main components: (a) indoor physical activity (“move inside”), (b) recess (“move outside”), (c) daily lessons (“move to learn”), and (d) social environment. Components were implemented using teacher and administrator trainings and workshops, site support visits, newsletters, and self-monitoring methods. Outcomes included accelerometer assessment of physical activity, sedentary behavior, and physical activity energy expenditure; weight status; and demographic factors; family/home social and physical environment; and parental characteristics. An extensive process evaluation
Martel, Sylvain; Mathieu, Jean-Baptiste; Felfoul, Ouajdi; Chanu, Arnaud; Aboussouan, Eric; Tamaz, Samer; Pouponneau, Pierre; Yahia, L'Hocine; Beaudoin, Gilles; Soulez, Gilles; Mankiewicz, Martin
The possibility of automatically navigating untethered microdevices or future nanorobots to conduct target endovascular interventions has been demonstrated by our group with the computer-controlled displacement of a magnetic sphere along a pre-planned path inside the carotid artery of a living swine. However, although the feasibility of propelling, tracking and performing real-time closed-loop control of an untethered ferromagnetic object inside a living animal model with a relatively close similarity to human anatomical conditions has been validated using a standard clinical Magnetic Resonance Imaging (MRI) system, little information has been published so far concerning the medical and technical protocol used. In fact, such a protocol developed within technological and physiological constraints was a key element in the success of the experiment. More precisely, special software modules were developed within the MRI software environment to offer an effective tool for experimenters interested in conducting such novel interventions. These additional software modules were also designed to assist an interventional radiologist in all critical real-time aspects that are executed at a speed beyond human capability, and include tracking, propulsion, event timing and closed-loop position control. These real-time tasks were necessary to avoid a loss of navigation control that could result in serious injury to the patient. Here, additional simulation and experimental results for microdevices designed to be targeted more towards the microvasculature have also been considered in the identification, validation and description of a specific sequence of events defining a new computer-assisted interventional protocol that provides the framework for future target interventions conducted in humans.
Kimhi, Einat; Reishtein, Judith L; Cohen, Miri; Friger, Michael; Hurvitz, Nancy; Avraham, Rinat
This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience.
Stewart, Duncan; Warren, Jonathan; Odubanwo, Adewunmi; Bowers, Len
Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients. PMID:26300518
Background Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. Methods/Design The care programme is based on Dutch national guidelines. It will consist of four steps: detection, analysis, treatment and evaluation. A stepped wedge design will be used. A total of 14 dementia special care units will implement the care programme. The primary outcome is behavioural problems. Secondary outcomes will include quality of life, prescription rate of antipsychotics, use of physical restraints and workload and job satisfaction of nursing staff. The effect of the care programme will be estimated using multilevel linear regression analysis. An economic evaluation from a societal perspective will also be carried out. Discussion The care programme is expected to be cost-effective and effective in decreasing behavioural problems, workload of nursing staff and in increasing quality of life of residents. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR 2141 PMID:21338502
Burton, Christopher; Rycroft-Malone, Jo; Williams, Lynne; Davies, Siân; McBride, Anne; Hall, Beth; Rowlands, Anne-M; Jones, Adrian
Introduction Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and ‘local knowledge’ is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers’ use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances? Methods and analysis To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice. Ethics and dissemination Ethical approval has been gained from the study's institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an
Blank, Michael B.; Hanrahan, Nancy P.; Fishbein, Martin; Wu, Evan S.; Tennille, Julie A.; Ten Have, Thomas R.; Kutney-Lee, Ann M.; Gross, Robert; Hines, Janet M.; Coyne, James C.; Aiken, Linda H.
Objective The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens. Methods Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients’ medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months. Results Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=−.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant. Conclusions This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced. PMID:22211211
This article provides an overview of motivational interviewing (MI) as an effective intervention for trauma informed care. It offers a description of trauma and its most commonly associated negative side effects in the school setting. Within this context, basic theoretical concepts of MI are discussed. The article closes by examining the need for future research regarding MI as an effective, school-based intervention for adolescents. PMID:26739933
Sörensen, Silvia; White, Katherine; Mak, Wingyun; Zanibbi, Katherine; Tang, Wan; O’Hearn, Amanda; Hegel, Mark T.
Age-related Macular Degeneration (AMD) is the leading cause of irreversible and predictable blindness among older adults and creates serious physical and mental health consequences for this population. Visual impairment is associated with negative future outlook and depression and has serious consequences for older adults’ quality of life and, by way of depression, on long-term survival. Psychosocial interventions have the potential to alleviate and prevent depression symptoms among older AMD patients. We describe the protocol of the Macular Degeneration and Aging Study, a randomized clinical trial of a psychosocial Preventive Problem-Solving Intervention. The intervention is aimed at enhancing well-being and future planning among older adults with macular degeneration by increasing preparation for future care. Adequate randomization and therapeutic fidelity were achieved. Current retention rates were acceptable, given the vulnerability of the population. Acceptability (adherence and satisfaction) is high. Given the high public health significance and impact on quality of life among older adults with vision loss, this protocol contributes a valid test of a promising intervention for maintaining mental and physical health in this population. PMID:25812482
Background Studies of implementation of efficacious human immunodeficiency virus (HIV) prevention interventions are rare, especially in resource-poor settings, but important, because they have the potential to increase the impact of interventions by improving uptake and sustainability. Few studies have focused on provider and organizational factors that may influence uptake and fidelity to core intervention components. Using a hybrid design, we will study the implementation of an efficacious intervention to reduce sexually transmitted infections (STIs) among female sex workers (FSWs) in 12 cities across Mexico. Our protocol will test a ‘train-the-trainer’ implementation model for transporting the Mujer Segura (Healthy Woman) intervention into community-based organizations (CBOs). Methods We have partnered with Mexican Foundation for Family Planning (Mexfam), a non-governmental organization that has CBOs throughout Mexico. At each CBO, trained ethnographers will survey CBO staff on characteristics of their organization and on their attitudes toward their CBO and toward the implementation of evidence-based interventions (EBIs). Then, after CBO staff recruit a sample of 80 eligible FSWs and deliver a standard-care, didactic intervention to 40 women randomly selected from that pool, a Mexfam staff person will be trained in the Mujer Segura intervention and will then train other counselors to deliver Mujer Segura to the 40 remaining participating FSWs. FSW participants will receive a baseline behavioral assessment and be tested for HIV and STIs (syphilis, gonorrhea, and chlamydia); they will be reassessed at six months post-intervention to measure for possible intervention effects. At the same time, both qualitative and quantitative data will be collected on the implementation process, including measures of counselors’ fidelity to the intervention model. After data collection at each CBO is complete, the relative efficacy of the Mujer Segura intervention will be
Background Increasing moderate to vigorous physical activity among urban girls of low socioeconomic status is both a challenge and a public health priority. Physical activity interventions targeting exclusively girls remain limited, and maintenance of moderate to vigorous physical activity during the post-intervention period has been difficult to maintain. The main aim of the 5-year “Girls on the Move” group randomized trial is to evaluate the efficacy of a comprehensive school-based intervention in increasing girls’ minutes of moderate to vigorous physical activity and improving cardiovascular fitness, body mass index, and percent body fat immediately post-intervention (after 17 weeks) and at 9-month post-intervention follow-up (9 months after end of intervention). Methods/Design A total of 24 urban middle schools in the Midwestern U.S. will be randomized to either receive the intervention or serve as a control (N = 1200 girls). The intervention, based on the Health Promotion Model and Self-Determination Theory, will include: (1) two face-to-face motivational, individually tailored counseling sessions with a registered nurse, one at the beginning and the other at the end of the intervention period; (2) an interactive Internet-based session during which each girl receives individually tailored motivational and feedback messages via iPad at 11 weeks (shortly after midpoint of intervention); and (3) a 90-minute after-school physical activity club. Racially diverse, low-active, 10- to 14-year-old 5th to 8th-grade girls will complete questionnaires and physical measures at baseline and post-intervention (n = 50 per school). Minutes of moderate to vigorous physical activity will be assessed with accelerometers. Cardiovascular fitness will be assessed by estimating VO2 max with PACER (Progressive Aerobic Cardiovascular Endurance Run) scores. Height and weight will be assessed to calculate body mass index. Percent body fat will be estimated with a foot
Rosenbaum, Simon; Nijjar, Sukh; Watkins, Andrew; Garwood, Natasha; Sherrington, Catherine; Tiedemann, Anne
The aim of the present study was to: (i) document the prevalence of risk factors for non-communicable diseases among mental health consumers (inpatients) with various diagnoses; and (ii) audit the frequency of waist circumference (WC) documentation before and after an intervention that involved a single nurse-education session, and change in assessment-form design. The study was undertaken in a private psychiatric hospital in Sydney, Australia. Twenty-five nurses participated in the educational intervention. File audits were performed prior to intervention delivery (n = 60), and 3 months' (n = 60), and 9 months' (n = 60) post-intervention. Files were randomly selected, and demographic (age, diagnosis) and risk factor (WC, body mass index (BMI), smoking status, blood pressure) data were extracted. WC was higher in this cohort compared to published general population means, and only 19% of patients had a BMI within the healthy range. In total, 37% of patients smoked, while 31% were hypertensive. At baseline, none of the audited files reported WC, which increased to 35 of the 60 (58%) files audited at the 3-month follow up. At the 9-month follow up, 25 of the 60 (42%) files audited reported a WC. In the 120 post-intervention files audited, only two patients refused measurement. These results illustrate the poor physical health of inpatients, and suggest that nurse-assessed metabolic monitoring can be enhanced with minimal training. PMID:24393271
Chien, Wai-Tong; Bressington, Daniel
This study aimed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness. A single-blind, parallel group, randomized controlled trial design was used. The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong. Patients were randomly assigned to either an eight-session nurse-led psychosocial intervention program (plus usual care) or usual psychiatric outpatient care (both n=90). The primary outcome was psychiatric symptoms. Outcomes were measured at recruitment, one week and 12 months post-intervention. Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual. There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up. The findings provide evidence that the nurse-led psychosocial intervention program resulted in improved health outcomes in Chinese patients with first-onset mental illness.
Interdisciplinary collaboration in the use of a music-with-movement intervention to promote the wellbeing of people with dementia and their families: Development of an evidence-based intervention protocol.
Lai, Claudia K Y; Lai, Daniel L L; Ho, Jacqueline S C; Wong, Kitty K Y; Cheung, Daphne S K
The music-with-movement intervention is particularly suitable for people with dementia because their gross motor ability is preserved until the later stage of dementia. This study examines the effect of music-with-movement on reducing anxiety, sleep disturbances, and improving the wellbeing of people with dementia. This paper reports the first stage of the study - developing the intervention protocol that staff can use to teach family caregivers. A registered music therapist developed a music-with-movement protocol and taught staff of two social service centers over five weekly 1.5 h sessions, with center-in-charges (social workers and occupational therapists) and our research team joining these sessions to provide comments from their professional perspective. Each discipline had different expectations about the content; therefore, numerous meetings and discussions were held to bridge these differences and fine-tune the protocol. Few healthcare professionals doubt the merits of interdisciplinary collaboration at all levels of health promotion. In practice, interdisciplinary collaboration is complex and requires commitment. Openness and persistence is required from all stakeholders to achieve a successful intervention for consumers.
van Gaal, Betsie GI; Knoll, Jacqueline L; Cornelissen, Elisabeth AM; Schoonhoven, Lisette; Kok, Gerjo
Background The care for children with a chronic kidney disease (CKD) is complex. Parents of these children may experience high levels of stress in managing their child’s disease, potentially leading to negative effects on their child’s health outcomes. Although the experienced problems are well known, adequate (online) support for these parents is lacking. Objective The objective of the study is to describe the systematic development of an online support program for parents of children with CKD, and how this program will be evaluated. Methods Intervention Mapping (IM) was used for the development of the program. After conducting a needs assessment, defining program objectives, searching for theories, and selecting practical applications, the online program e-Powered Parents was developed. e-Powered Parents consist of three parts: (1) an informative part with information about CKD and treatments, (2) an interactive part where parents can communicate with other parents and health care professionals by chat, private messages, and a forum, and (3) a training platform consisting of four modules: Managing stress, Setting limits, Communication, and Coping with emotions. In a feasibility study, the potential effectiveness and effect size of e-Powered Parents will be evaluated using an explorative randomized controlled trial with parents of 120 families. The outcomes will be the child’s quality of life, parental stress and fatigue, self-efficacy in the communication with health care professionals, and family management. A process evaluation will provide insight in parents’ experiences, including their experienced level of support. Results Study results are expected to be published in the summer of 2016. Conclusions Although the development of e-Powered Parents using IM was time-consuming, IM has been a useful protocol. IM provided us with a systematic framework for structuring the development process. The participatory planning group was valuable as well; knowledge
Resnick, N M; Brandeis, G H; Baumann, M M; Morris, J N
Evaluation of 1 million incontinent American nursing home residents is hampered by both failure to detect incontinence and logistical barriers to diagnostic testing. The nationally mandated Minimum Data Set (MDS) and Resident Assessment Protocol (RAP) were devised to address these deficiencies. Although both instruments are also used in at least 18 other countries, neither has been evaluated. Our goal was to determine the reliability of the MDS and the accuracy of the RAP in predicting the lower urinary tract cause of incontinence. We determined interrater reliability for the 13 MDS items related to urinary incontinence in 123 randomly selected residents of 13 nursing homes in 5 states; forms were completed blindly by 2 nurses from each facility who were trained for a day. The RAP was assessed in 102 representative institutionalized women by blinded evaluation of its diagnostic accuracy compared with the multichannel videourodynamic criterion standard. For the MDS, interrater reliability for incontinence of all grades was excellent (weighted kappa correlation coefficient = 0.90), although reliability was greater at the extremes of measurement than for incontinence of intermediate severity. With the exception of delirium, correlations for the 11 MDS items related to incontinence were 0.65-0.96; for 6 items, correlations were > or = 0.8. The diagnostic accuracy of the RAP, successfully administered to 80% of women, was 70%. The accuracy of the nearly identical algorithm that formed the basis for the RAP was 84%. Importantly, serious misclassifications were not observed for either the RAP or the algorithm. Although its definitions should be modified slightly, the MDS appears to be feasible and reliable when administered by trained staff. In women, the diagnostic accuracy and safety of the RAP are good-particularly when administered as instructed-but the original, sex-specific algorithm is preferable. Together, the MDS and modified RAP provide a useful, stepwise, and
Abedian, Kobra; Nesami, Masumeh Bagheri; Shahhosseini, Zohreh
Background: For patients’ rights to be observed, first patients and health care providers should be aware of these rights. Nurses’ lack of awareness of these rights leads to their inability to recognize patients’ legal and ethical issues, and reduces the quality of provided services. This study was conducted to determine the effect of an education-based intervention on self-reported awareness and practice of nurses in observing patients’ rights. Methods: In this quasi-experimental study, awareness and practice of 90 nurses on Patient’s Bill of Rights were examined in case and control groups, before, 2 and 4 weeks after an educational intervention program on. Participants were selected from teaching hospitals of Mazandaran University of Medical Sciences, Iran. Data was gathered using the valid and reliable 21-item questionnaire in a 3-point Likert scale during a 5-month period from October 2013 to March 2014. For data analysis, descriptive statistical methods, paired t-test, and repeated measure analysis of variance at significant level P<0.05 were used. Results: Participants’ mean age and work experience were found 37.1±5.71 years and 11.76±5.99 years respectively. Mean scores of nurses’ awareness and practice before intervention were 15.12±2.19 and 9.13±2.36, accordingly. Repeated measure analysis of variance test showed a significant difference in awareness and practice of nurses before and after intervention (P<0.001). Conclusion: Enhancing nurses’ awareness on Patient’s Bill of Rights through revision of educational curriculum in nursing schools, together with considering appropriate relevant content in continuous education programs in health systems can lead to improved quality of nursing care services. PMID:25948445
Background Osteoporosis is a debilitating disease and its risk can be reduced through adequate calcium consumption and physical activity. This protocol paper describes a workplace-based intervention targeting behaviour change in premenopausal women working in sedentary occupations. Method/Design A cluster-randomised design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the clusters and units of randomisation and intervention. Sample size calculations incorporated the cluster design. Final number of clusters was determined to be 16, based on a cluster size of 20 and calcium intake parameters (effect size 250 mg, ICC 0.5 and standard deviation 290 mg) as it required the highest number of clusters. Sixteen workplaces were recruited from a pool of 97 workplaces and randomly assigned to intervention and control arms (eight in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organisation wide educational activities. Workplaces in the control/standard care arm received print resources. Intervention workshops were guided by self-efficacy theory and included participatory activities such as goal setting, problem solving, local food sampling, exercise trials, group discussion and behaviour feedback. Outcomes measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, four weeks and six months post intervention. Discussion This study addresses the current lack of evidence for behaviour change interventions focussing on osteoporosis prevention. It addresses missed opportunities of using workplaces as a platform to target high-risk individuals with sedentary occupations. The intervention was designed to modify behaviour levels to bring about risk reduction. It is the first to address dietary and physical activity components each with unique intervention
Mendell, Mark; Eliseeva, Ekaterina; Spears, Michael; Fisk, William J.
We developed and pilot-tested an overall protocol for intervention studies to evaluate the effects of indoor environmental changes in office buildings on the health symptoms and comfort of occupants. The protocol includes a web-based survey to assess the occupant's responses, as well as specific features of study design and analysis. The pilot study, carried out on two similar floors in a single building, compared two types of ventilation system filter media. With support from the building's Facilities staff, the implementation of the filter change intervention went well. While the web-based survey tool worked well also, low overall response rates (21-34percent among the three work groups included) limited our ability to evaluate the filter intervention., The total number of questionnaires returned was low even though we extended the study from eight to ten weeks. Because another simultaneous study we conducted elsewhere using the same survey had a high response rate (>70percent), we conclude that the low response here resulted from issues specific to this pilot, including unexpected restrictions by some employing agencies on communication with occupants.
Geraghty, Adam W A; Stanford, Rosie; Little, Paul; Roberts, Lisa; Foster, Nadine E; Hill, Jonathan C; Hay, Elaine; Stuart, Beth; Turner, David; Yardley, Lucy
Introduction Low back pain (LBP) is a prevalent and costly condition. The majority of patients experiencing LBP are managed in primary care, where first-line care recommendations consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity. Methods/analysis This protocol describes a single-blind, randomised controlled feasibility trial of an internet intervention developed to support the self-management of LBP in primary care. Patients are being randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of an internet intervention or an internet intervention with physiotherapist telephone support. Patients are followed up at 3 months. Primary outcomes are the feasibility of (1) the trial design/methods, (2) the delivery of the internet intervention and (3) the provision of telephone support by physiotherapists. Secondary outcomes will include exploratory analysis of estimates and variation in clinical outcomes of pain and disability, in order to inform a future main trial. Ethics/dissemination This feasibility trial has undergone ethical scrutiny and been approved by the National Health Service (NHS) Research Ethics Committee, REC Reference 13/SC/0202. The feasibility findings will be disseminated to the research community through presentations at conferences and publication in peer review journals. Broader dissemination will come following a definitive trial. Trial registration number ISRCTN 31034004. PMID:26399575
Infertility and its treatment may cause life crises in infertile women. The purpose of this study is to evaluate the effects of a crisis intervention program on improving psychosocial responses and enhancing coping strategies for infertile women attending different stages of an In-Vitro Fertilization V Embryo Transfer (IVF-ET) treatment program. Using an experimental study design, infertile women attending an IVF-ET treatment program were randomly assigned to experimental and control groups. In the experimental group, infertile women completed and answered a questionnaire and received nursing crisis intervention at the initial stage of treatment (day 3). This included (1). viewing a video explaining the therapeutic process of IVF-ET, (2). self-hypnosis and muscle relaxation training, and (3). provision of cognitive-behavioral counseling. The same questionnaire was used again for subjects at the stage of embryo transfer and before taking a pregnancy test. The women in the control group were only interviewed using the same questionnaire and at the same times as the experimental group. Analysis by repeated measurement ANOVA demonstrated that there was a reduction in psychosocial response in terms of interpersonal relationships, and there was an interaction between intervention effects and stage of treatment. However, there was no statistically significant difference in the level of psychosocial responses between the experimental and control groups although some meaningful findings were made. However, in terms of state of anxiety, confrontational problems, and isolated mind/body relaxation, there were significant differences between the two groups of infertile women at some stages of IVF-ET treatment. The women in the experimental group perceived a positive effect of the nursing intervention in relieving their psychosocial responses. The results of this nursing crisis intervention could be helpful in nursing practice when dealing with infertile women attending IVF
Vílchez Barboza, Vivian; Klijn, Tatiana Paravic; Salazar Molina, Alide; Sáez Carrillo, Katia Lorena
Abstract Objective: to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. Method: a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. Results: women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. Conclusion: this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life. PMID:27508917
Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are– (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders, (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders and (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12612000825853 PMID:24533916
Mahendran, Rathi; Tan, Joyce Yi Siang; Griva, Konstadina; Lim, Haikel Asyraf; Ng, Hui Ying; Chua, Joanne; Lim, Siew Eng; Kua, Ee Heok
Introduction Despite the rising trend of cancer prevalence and increase in family caregiving, little attention has been paid to the efficacy of psychosocial interventions among Asian caregiver samples, particularly support groups, given the benefits that have been shown in studies on Western populations. This trial aims to evaluate the effectiveness of a pilot 4-week group psychotherapy for Singaporean family caregivers of patients receiving outpatient care. Methods and analysis Facilitated by a clinical psychologist, this intervention is primarily based on the brief integrative psychological therapy with a supportive-expressive intent. Participants will be recruited while they are accompanying their care recipients for outpatient consultations. Since this is a pilot study, a sample size of 120 participants is targeted on the basis of sample sizes of previous studies. The study adopts a quasi-experimental design, as participants are assigned the intervention or control arms based on their availability to attend the intervention. A mixed methods approach is used to evaluate the outcomes of the intervention. A self-administered battery of tests is completed at four time points: baseline, postintervention and follow-up at 1-month and 2-month postinterventions; semi-structured interviews are conducted at baseline and post-intervention. Primary outcomes are quality of life and anxious and depressive symptoms; secondary outcomes are stress and basic psychological needs. Analysis using analysis of covariance would be conducted to determine the effectiveness of the intervention. Ethics and dissemination This study protocol has ethics approval from the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref: 2013/00662). Written informed consent is obtained from every participant. Results will be disseminated through journals and conferences, and will be particularly relevant for clinicians intending to implement similar support groups to address the
Ruggiero, Kenneth J.; Davidson, Tatiana M.; McCauley, Jenna; Gros, Kirstin Stauffacher; Welsh, Kyleen; Price, Matthew; Resnick, Heidi S.; Danielson, Carla Kmett; Soltis, Kathryn; Galea, Sandro; Kilpatrick, Dean G.; Saunders, Benjamin E.; Nissenboim, Josh; Muzzy, Wendy; Fleeman, Anna; Amstadter, Ananda B.
Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several web based evaluation studies with various adult populations has shown that web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and web-based assessments, and development and evaluation of a highly individualized web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice. PMID:25478956
Ruggiero, Kenneth J; Davidson, Tatiana M; McCauley, Jenna; Gros, Kirstin Stauffacher; Welsh, Kyleen; Price, Matthew; Resnick, Heidi S; Danielson, Carla Kmett; Soltis, Kathryn; Galea, Sandro; Kilpatrick, Dean G; Saunders, Benjamin E; Nissenboim, Josh; Muzzy, Wendy; Fleeman, Anna; Amstadter, Ananda B
Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.
Ruggiero, Kenneth J; Davidson, Tatiana M; McCauley, Jenna; Gros, Kirstin Stauffacher; Welsh, Kyleen; Price, Matthew; Resnick, Heidi S; Danielson, Carla Kmett; Soltis, Kathryn; Galea, Sandro; Kilpatrick, Dean G; Saunders, Benjamin E; Nissenboim, Josh; Muzzy, Wendy; Fleeman, Anna; Amstadter, Ananda B
Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice. PMID:25478956
Abaraogu, Ukachukwu Okoroafor; Dall, Philippa Margaret; Seenan, Christopher Andrew
Introduction Peripheral arterial disease (PAD) and intermittent claudication (IC) decrease an individual's capacity to engage in physical activity (PA) with potentially negative effects on PA behaviour. Strategies to improve PA among this population may provide a range of positive health benefits. We present a protocol to assess the components of patient education interventions that improve PA capacity and PA behaviour in patients with PAD and IC. Methods and analysis Published peer-reviewed studies will be searched in the following databases: CINAHL, the Cochrane Library, OVID, ProQuest, AMED, MEDLINE, PsycINFO, Web of Science Core Collection and PEDro, to identify literature investigating the effect of patient education on PA of patients with PAD and IC, or studies that investigated patients' perceptions or experience with these interventions. Two authors will independently perform screening for study eligibility, result synthesis and then appraise study quality. For interventions without follow-up, primary outcome measures will include change in PA capacity, or change in free-living PA behaviour; where there was a follow-up postintervention, the primary outcome will be rate of adherence to PA behaviour improvement. A three-phase sequential explanatory synthesis of mixed studies will be employed to answer the research questions. Homogenous quantitative data will be analysed using a random-effects model of meta-analysis with results presented as relative risk for dichotomous outcomes and as weighted or standardised means for continuous outcomes. Qualitative data will be analysed using thematic synthesis. This review protocol is reported according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. Trial registration number CRD42015027314. PMID:27207628
Background Many cancer patients have problems performing activities of daily living (ADL). A randomised controlled trial was designed to examine the effects of an ADL intervention in addition to standard treatment and care in a hospital setting. The objective of this article was to present the study and to analyse the feasibility of the recruitment process and the intervention. Methods Adult disabled cancer patients at Næstved Hospital in Denmark were enrolled between 1 March 2010 and 30 June 2011 and randomised into an ADL intervention or to a control group. The intervention was performed by occupational therapists. The feasibility of the recruitment was analysed with regard to success in achieving the estimated number of participants and identification of barriers, and feasibility of the intervention was based on calculations of patient attendance and patient acceptability. The primary outcome of the randomised controlled trial was patients’ health-related quality of life 2 and 8 weeks after baseline. Results A total of 118 disabled cancer patients were enrolled in the study over a time span of 16 months. Very few meetings between occupational therapist and patient were cancelled. Time spent on the intervention varied considerably, but for the majority of patients, time consumption was between 1–3 hours. Conclusions Despite difficulties with recruitment, participation was considered feasible and the intervention was accepted among patients. Missing data in the follow-up period were mostly due to death among participants. Very few participants declined to complete questionnaires during follow-up. PMID:24779438
Brandt, Mikkel; Møller, Jeppe Lykke; Skals, Sebastian; Vinstrup, Jonas; Jakobsen, Markus Due; Sundstrup, Emil; Madeleine, Pascal; Andersen, Lars Louis
Background Previous research has shown that reducing physical workload among workers in the construction industry is complicated. In order to address this issue, we developed a process evaluation in a formative mixed-methods design, drawing on existing knowledge of the potential barriers for implementation. Objective We present the design of a mixed-methods process evaluation of the organizational, social, and subjective practices that play roles in the intervention study, integrating technical measurements to detect excessive physical exertion measured with electromyography and accelerometers, video documentation of working tasks, and a 3-phased workshop program. Methods The evaluation is designed in an adapted process evaluation framework, addressing recruitment, reach, fidelity, satisfaction, intervention delivery, intervention received, and context of the intervention companies. Observational studies, interviews, and questionnaires among 80 construction workers organized in 20 work gangs, as well as health and safety staff, contribute to the creation of knowledge about these phenomena. Results At the time of publication, the process of participant recruitment is underway. Conclusions Intervention studies are challenging to conduct and evaluate in the construction industry, often because of narrow time frames and ever-changing contexts. The mixed-methods design presents opportunities for obtaining detailed knowledge of the practices intra-acting with the intervention, while offering the opportunity to customize parts of the intervention. PMID:27230696
Voice-Message–Based mHealth Intervention to Reduce Postoperative Penetrative Sex in Recipients of Voluntary Medical Male Circumcision in the Western Cape, South Africa: Protocol of a Randomized Controlled Trial
Skinner, Donald; Toefy, Yoesrie; Esterhuizen, Tonya; McCaul, Michael; Petzold, Max; Diwan, Vinod
Background There is an increased risk of transmission of sexually transmitted infections (STIs), including HIV, in the postoperative period after receiving voluntary medical male circumcision (VMMC). In South Africa, over 4 million men are being targeted with VMMC services but the health system is not able to offer quality counseling. More innovative strategies for communicating with and altering behavior in men and their partners in the postoperative period after VMMC are needed. Objective This paper presents a study protocol to test the effectiveness of an mHealth intervention designed to task-shift behavior change communication from health care personnel to an automated phone message system, encouraging self-care. Methods A single-blind, randomized controlled trial will be used. A total of 1188 participants will be recruited by nurses or clinicians at clinics in the study districts that have a high turnover of VMMC clients. The population will consist of men aged 18 years and older who indicate at the precounseling session that they possess a mobile phone and consent to participating in the study. Consenting participants will be randomized into either the control or intervention arm before undergoing VMMC. The control arm will receive the standard of care (pre- and postcounseling). The intervention arm will received standard of care and will be sent 38 messages over the 6-week recovery period. Patients will be followed up after 42 days. The primary outcome is self-reported sexual intercourse during the recovery period. Secondary outcomes include nonpenetrative sexual activity, STI symptoms, and perceived risk of acquiring HIV. Analysis will be by intention-to-treat. Results Enrollment is completed. Follow-up is ongoing. Loss to follow-up is under 10%. No interim analyses have been conducted. Conclusions The intervention has the potential of reducing risky sexual behavior after VMMC. The platform itself can be used for many other areas of health that require task
Husain, Nusrat; Gire, Nadeem; Kelly, James; Duxbury, Joy; McKeown, Mick; Riley, Miv; Taylor, Christopher DJ; Taylor, Peter J; Emsley, Richard; Farooq, Saeed; Caton, Neil; Naeem, Farooq; Kingdon, David; Chaudhry, Imran
Objectives: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App. Methods: The TechCare App will assess participant’s symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8–10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service. Results: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants. Conclusion: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally. PMID:27790373
Background Eating out of the home has been associated with higher intakes of energy and fat and lower micronutrient intakes, as well as the development of obesity. Out-of-home food outlets (OHFOs) and the foods obtained from these outlets are an ideal target for interventions to improve diet and tackle obesity. This systematic review will explore the evidence for the effectiveness of promoting healthy behaviour through interventions that modify food practices in specific OHFOs. Methods/Design We will search the databases MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA and the NHS Economic Evaluation Database for studies that have evaluated interventions conducted in an OHFO that aim to promote healthier menu offerings. OHFOs which are not openly accessible to the general public and supermarkets will be excluded. Included study designs will be randomised controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series studies and evaluations of single interventions where outcome measures were assessed at least once pre and post-intervention (repeated measures studies). Discussion This systematic review aims to synthesise the available evidence with regard to interventions that aim to change specific OHFOs in order to promote healthier menu offerings. The findings of this review will provide information on the types of interventions that have been evaluated and the context in which they are set, and provide insights into what interventions, and intervention functions, are most effective in different OHFO settings, along with any important innovation, implementation and cost implications. The review has been registered with PROSPERO (registration no. CRD42013006931). PMID:24565102
Morgan, Jennifer Craft; Konrad, Thomas R.
Purpose: The purpose of this study was to evaluate WIN A STEP UP, a workforce development program for nursing assistants (NAs) in nursing homes (NHs) involving continuing education by onsite trainers, compensation for education modules, supervisory skills training of frontline supervisors, and short-term retention contracts for bonuses and/or wage…
Background The Pre-Consultation Educational Group Intervention pilot study seeks to assess the feasibility and inform the optimal design for a definitive randomized controlled trial that aims to improve the quality of decision-making in postmastectomy breast reconstruction patients. Methods/design This is a mixed-methods pilot feasibility randomized controlled trial that will follow a single-center, 1:1 allocation, two-arm parallel group superiority design. Setting: The University Health Network, a tertiary care cancer center in Toronto, Canada. Participants: Adult women referred to one of three plastic and reconstructive surgeons for delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction. Intervention: We designed a multi-disciplinary educational group workshop that incorporates the key components of shared decision-making, decision-support, and psychosocial support for cancer survivors prior to the initial surgical consult. The intervention consists of didactic lectures by a plastic surgeon and nurse specialist on breast reconstruction choices, pre- and postoperative care; a value-clarification exercise led by a social worker; and discussions with a breast reconstruction patient. Control: Usual care includes access to an informational booklet, website, and patient volunteer if desired. Outcomes: Expected pilot outcomes include feasibility, recruitment, and retention targets. Acceptability of intervention and full trial outcomes will be established through qualitative interviews. Trial outcomes will include decision-quality measures, patient-reported outcomes, and service outcomes, and the treatment effect estimate and variability will be used to inform the sample size calculation for a full trial. Discussion Our pilot study seeks to identify the (1) feasibility, acceptability, and design of a definitive RCT and (2) the optimal content and delivery of our proposed educational group intervention. Thirty patients have been
Background Childhood overweight has noticeable psychological and social consequences for the child and leads to an increased risk of mortality and morbidity later in life. With the high prevalence of overweight in children and adolescents, it is important to identify effective approaches for the prevention and treatment of overweight in children and young individuals. The primary aim of the study is to assess the effect of an intensive day-camp intervention on body mass index (BMI) in overweight children. Methods The Odense Overweight Intervention Study is a semi-blinded randomized controlled trial. Overweight children from the Municipality of Odense, Denmark, were invited to participate in the trial. Based on power calculations 98 participants were found to be sufficient to randomize in order to find an effect of minimum 1.5 BMI points. Gender-stratified concealed block randomization with a ratio of 1:1 and random block sizes of two, four, and six ensured balance between study arms. The intervention consisted of a six-week multi-component day camp including increased physical activity, healthy diet and health education followed by 46 weeks of family-based habitual intervention. The standard care arm was offered two weekly hours of physical activity training for six weeks. The outcomes were measured at baseline and at six-week and 52-week follow-ups. Furthermore, BMI will be assessed again at 48-month follow-up. Test personnel were kept blinded. The intervention effect will be evaluated using mixed model analyses. During 2012 and 2013, 115 children were enrolled in the study. Fifty-nine children were randomized to the day-camp intervention arm and 56 to the standard intervention arm. Discussion This study will provide novel information about the long-term health effects of an intense day-camp intervention program on overweight children, due to the design and the follow-up period. Moreover, it will add to the knowledge on designing and implementing feasible camp
Fortinsky, Richard H.; Delaney, Colleen; Harel, Ofer; Pasquale, Karen; Schjavland, Elena; Lynch, John; Kleppinger, Alison; Crumb, Suzanne
Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients experienced no significant cognitive decline during their 12-month study period, helping explain why outcomes did not change. Given widespread acceptability, future tests of this PCP-enhancing intervention should include patients with more progressive cognitive decline at study entry. NPs with geropsychiatric expertise are ideal interventionists for this rapidly growing target population. PMID:24444453
Fahrenkrug, Mary Ann
School nurses need to clearly identify how they promote the health and educational achievement of children. School nurses contribute to student health by providing health assessment and nursing interventions, advocating for healthy living, and contributing to prevention of illness and disease management. A Nursing Data Set for School Nursing can…
Background Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions. Objectives The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures. Methods A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings. Discussion The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices. PMID:23578304
Background Lack of adherence to recommended treatment for obstructive sleep apnea remains an ongoing public health challenge. Despite evidence that continuous positive airway pressure (CPAP) is effective and improves overall quality of life, adherence with the use of CPAP in certain racial/ethnic groups, especially blacks, is suboptimal. Evidence indicates that the incidence and prevalence of obstructive sleep apnea are higher among blacks, relative to whites, and blacks are less likely to adhere to recommended treatment compared with other racial/ethnic groups. Methods Using a two-arm randomized controlled design, this study will evaluate the effectiveness of a culturally and linguistically tailored telephone-delivered intervention to promote adherence to physician-recommended sleep apnea assessment and treatment among blacks with metabolic syndrome, versus an attention-control arm. The intervention is designed to foster adherence to recommended sleep apnea care using the stages-of-change model. The intervention will be delivered entirely over the telephone. Participants in the intervention arm will receive 10 phone calls to address challenges and barriers to recommended care. Outcomes will be assessed at baseline, and at 6- and 12-months post-randomization. Discussion This tailored behavioral intervention will improve adherence to sleep apnea assessment and treatment among blacks with metabolic syndrome. We expect to demonstrate that this intervention modality is feasible in terms of time and cost and can be replicated in populations with similar racial/ethnic backgrounds. Trial registration The study is registered at clinicaltrials.gov NCT01946659 (February 2013) PMID:24925227
Suganuma, Aya M; Shinohara, Kiyomi; Imai, Hissei; Takeshima, Nozomi; Hayasaka, Yu
Introduction Abstracts are the major and often the most important source of information for readers of the medical literature. However, there is mounting criticism that abstracts often exaggerate the positive findings and emphasise the beneficial effects of intervention beyond the actual findings mentioned in the corresponding full texts. In order to examine the magnitude of this problem, we will introduce a systematic approach to detect overstated abstracts and to quantify the extent of their prevalence in published randomised controlled trials (RCTs) in the field of psychiatry. Methods and analysis We will source RCTs published in 2014 from the Cochrane Register of Controlled Trials (CENTRAL) that claim effectiveness of any intervention for mental disorders. The abstract conclusions will be categorised into three types: superior (only stating significant superiority of intervention to control), limited (suggesting that intervention has limited superiority to control) and equal (claiming equal effectiveness of intervention as control). The full texts will also be classified as one of the following based on the primary outcome results: significant (all primary outcomes were statistically significant in favour of the intervention), mixed (primary outcomes included both significant and non-significant results) or all non-significant results. By comparing the abstract conclusion classification and that of the corresponding full text, we will assess whether each study exhibited overstatements in its abstract conclusion. Ethics and dissemination This trial requires no ethical approval. We will publish our findings in a peer-reviewed journal. Trial registration number UMIN000018668; Pre-results. PMID:27103624
Tiemessen, Ivo JH; Hulshof, Carel TJ; Frings-Dresen, Monique HW
Background Whole body vibration (WBV) exposure at work is common and studies found evidence that this exposure might cause low back pain (LBP). A recent review concluded there is a lack of evidence of effective strategies to reduce WBV exposure. Most research in this field is focussed on the technical implications, although changing behaviour towards WBV exposure might be promising as well. Therefore, we developed an intervention programme to reduce WBV exposure in a population of drivers with the emphasis on a change in behaviour of driver and employer. The hypothesis is that an effective reduction in WBV exposure, in time, will lead to a reduction in LBP as WBV exposure is a proxy for an increased risk of LBP. Methods/Design The intervention programme was developed specifically for the drivers of vibrating vehicles and their employers. The intervention programme will be based on the most important determinants of WBV exposure as track conditions, driving speed, quality of the seat, etc. By increasing knowledge and skills towards changing these determinants, the attitude, social influence and self-efficacy (ASE) of both drivers and employers will be affected having an effect on the level of exposure. We used the well-known ASE model to develop an intervention programme aiming at a change or the intention to change behaviour towards WBV exposure. The developed programme consists of: individual health surveillance, an information brochure, an informative presentation and a report of the performed field measurements. Discussion The study protocol described is advantageous as the intervention program actively tries to change behaviour towards WBV exposure. The near future will show if this intervention program is effective by showing a decrease in WBV exposure. PMID:18005400
Kurebayashi, Leonice Fumiko Sato; da Silva, Maria Júlia Paes
Objective this randomized single blind clinical study aimed to evaluate the efficacy of auriculotherapy with and without a protocol for reducing stress levels among nursing staff. Method a total of 175 nursing professionals with medium and high scores according to Vasconcelos' Stress Symptoms List were divided into 3 groups: Control (58), Group with protocol (58), Group with no protocol (59). They were assessed at the baseline, after 12 sessions, and at the follow-up (30 days). Results in the analysis of variance, statistically significant differences between the Control and Intervention groups were found in the two evaluations (p<0.05) with greater size of effect indices (Cohen) for the No protocol group. The Yang Liver 1 and 2, Kidney, Brain Stem and Shen Men were the points most used. Conclusion individualized auriculotherapy, with no protocol, could expand the scope of the technique for stress reduction compared with auriculotherapy with a protocol. NCT: 01420835 PMID:25029046
Nurses care for elderly patients at home and in nursing homes but there is lack of data on the caring problems encountered, their causes and the solutions adopted. The aim of the study is to produce the epidemiology of such problems and, at the same time, focus nurses' attention on their causes and avoidability. The process of definition of caring problems (the focus of the study) and the discussion that brought to the draft protocol are described. The final protocol (presented with the data collection forms) is articulated in two phases: a prevalence survey through a random sampling of points estimates in index days over 6 months; a prospective registry over the same period of time of all causes perceived as clinically relevant by the nursing personnel, who will document the suspected risk factors and causes (including specifically drug therapy), and the interventions and measures which are activated.
Over the last 4 decades, rates of stroke occurrence in low- and middle-income countries (LMIC) have roughly doubled, whereas they have substantively decreased in high-income countries. Most of these LMIC are in Sub-Saharan Africa (SSA) where the burden of stroke will probably continue to rise over the next few decades because of an ongoing epidemiologic transition. Moreover, SSA is circumstantially distinct: socioeconomic obstacles, cultural barriers, underdiagnosis, uncoordinated care, and shortage of physicians impede the ability of SSA countries to implement cardiovascular disease prevention among people with diabetes mellitus in a timely and sustainable manner. Reducing the burden of stroke in SSA may necessitate an initial emphasis on high-risk individuals motivated to improve their health, multidisciplinary care coordination initiatives with clinical decision support, evidence-based interventions tailored for cultural relevance, task shifting from physicians to nurses and other health providers, use of novel patient-accessible tools, and a multilevel approach that incorporates individual- and system-level components. This article proposes a theory-based integrated blood pressure (BP) self-management intervention called Phone-based Intervention under Nurse Guidance after Stroke (PINGS) that could be tested among hospitalized stroke patients with poorly controlled hypertension encountered in SSA. PINGS would comprise the implementation of nurse-run BP control clinics and administration of health technology (personalized phone text messaging and home telemonitoring), aimed at boosting patient self-efficacy and intrinsic motivation for sustained adherence to antihypertensive medications. PMID:25440360
Over the last four decades, rates of stroke occurrence in low-and middle-income countries (LMIC) have roughly doubled, whereas they have substantively decreased in high income countries (HIC). The majority of these LMIC are in Sub-Saharan Africa (SSA) where the burden of stroke will probably continue to rise over the next few decades due to an ongoing epidemiological transition. Moreover, SSA is circumstantially distinct: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians impede the ability of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. Reducing the burden of stroke in SSA may necessitate an initial emphasis on high-risk individuals motivated to improve their health, multidisciplinary care coordination initiatives with clinical decision support, evidence-based interventions tailored for cultural relevance, task shifting from physicians to nurses and other health providers, use of novel patient-accessible tools, and a multi-level approach that incorporates individual- and system- level components. This article proposes a theory-based integrated blood pressure self-management intervention called Phone-based Intervention under Nurse Guidance after Stroke (PINGS) that could be tested among hospitalized stroke patients with poorly controlled HTN encountered in SSA. PINGS would comprise the implementation of nurse-run BP control clinics and administration of health technology (personalized phone text messaging and home telemonitoring), aimed at boosting patient self-efficacy and intrinsic motivation for sustained adherence to antihypertensive medications. PMID:25440360
Lamet, Ann R.; Sonshine, Rosanne; Walsh, Sandra M.; Molnar, David; Rafalko, Sharon
Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students' attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students' willingness to take care of them. Using a self-transcendence conceptual framework, control (n = 56) and experimental (n = 14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P = .008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P = .08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested. PMID:21994833
Background Community pharmacists can deliver health care advice at an opportunistic level, related to prescription or non-prescription medicines and as part of focused services designed to reduce specific risks to health. Obesity, smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK, and interventions led by community pharmacists, aimed at these three risk factors, have been identified by the government as public health priorities. In 2008, the Department of Health for England stated that ‘a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed’; this systematic review aims to respond to this requirement. Methods/design We will search the databases MEDLINE, Embase, CINAHL, PsycINFO, Social Sciences Citation Index, ASSIA, IBSS, Sociological Abstracts, Scopus and NHS Economic Evaluation Database for studies that have evaluated interventions based on community pharmacies that aim to target weight management, smoking cessation and alcohol misuse. We will include all randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) and repeated measures studies. Data from included studies will be extracted by two independent reviewers and will include study details methods, results, intervention implementation/costs and methodological quality. Meta-analysis will be conducted if appropriate; if not, the synthesis will be restricted to a narrative overview of individual studies looking at the same question. Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management, smoking cessation and alcohol misuse. It will also explore if, and how, socio-economic status, gender, ethnicity and age moderate the effect of the
The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults
Hurley, Jane C; Hollingshead, Kevin E; Todd, Michael; Jarrett, Catherine L; Tucker, Wesley J; Angadi, Siddhartha S
Background Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health. Objective Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults’ PA compared to the static intervention components. Methods Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message–based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants’ daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising. Results This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016. Conclusions The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently
Background Up to 70% of cancer survivors report clinically significant levels of fear of cancer recurrence (FCR). Despite the known negative impact of FCR on psychological wellbeing and quality of life, little research has investigated interventions for high FCR. Our team has developed and piloted a novel intervention (Conquer Fear) based on the Self-Regulatory Executive Function Model and Relational Frame Theory and is evaluating Conquer Fear in a randomised controlled trial (RCT). We aim to compare the efficacy and cost-efficacy of the Conquer Fear Intervention and relaxation training in reducing the impact of FCR. Methods/design This study is a multi-centre RCT with 260 participants randomised either to the Conquer Fear Intervention or relaxation training. Both interventions will be delivered in five sessions over 10 weeks by trained psychologists, psychiatrists and social workers with five or more years experience in oncology. Conquer Fear sessions use attentional training, detached mindfulness, meta-cognitive therapy, values clarification and psycho-education to help patients change the way they regulate and respond to thoughts about cancer recurrence. Relaxation training includes training in progressive and passive muscle relaxation, meditative relaxation, visualisation and “quick relaxation” techniques. Relaxation was chosen to control for therapist time and attention and has good face-validity as an intervention. The primary outcome is fear of cancer recurrence. Secondary outcomes include distress, quality of life, unmet needs, and health care utilisation. Participants complete questionnaires prior to starting the intervention, immediately after completing the intervention, 3 and 6 months later. Eligible participants are early-stage breast or colorectal cancer survivors who have completed hospital-based treatment between 2 months and 5 years prior to study entry and report a score in the clinical range on the Fear of Cancer Recurrence Inventory. The
Background Over 65% of stroke survivors are either overweight or obese and have multiple cardiovascular risk factors. However, few studies have examined the effects of comprehensive lifestyle behavior interventions to promote weight loss and control cardiovascular risk factors in stroke survivors. Thus, the purpose of this study is to examine a novel behavior change approach - SystemCHANGE™ - to promote weight loss and improve health and function in stroke survivors. SystemCHANGE™ focuses on redesigning the social environment to achieve a specific goal. Methods We will conduct a randomized controlled pilot study to examine the efficacy, feasibility, and safety of the SystemCHANGE™ weight management program in overweight and obese stroke survivors. The central hypothesis of the study is that the SystemCHANGE™ intervention will help overweight and obese stroke survivors lose 5% of their body weight, thereby improving health and function. Thirty-five stroke survivors will be randomized into either the 6-month SystemCHANGE™ intervention or a contact-control intervention. Outcome measures will be assessed at baseline and again at 3 and 6 months after the interventions. Body composition will be assessed using a Bod Pod. Patient-reported outcomes will be the Stroke Impact Scale and Reintegration to Normal Living Index. Objective outcomes will include the 6-Minute Walking Test and Rivermead Motor Assessment. Discussion This study will be the first randomized controlled trial to evaluate the efficacy and safety of a weight management intervention in stroke survivors using the SystemCHANGE™ approach. Furthermore, it will be the first empirically-examined comprehensive lifestyle intervention designed to target physical activity, nutrition, and sleep to promote weight loss in stroke survivors. Trial registration ClinicalTrials.gov Identifier: NCT01776034 PMID:23782741
Background There are an increasing number of studies reporting the efficacy of educational strategies to facilitate the development of knowledge and skills underpinning evidence based practice (EBP). To date there is no standardised guideline for describing the teaching, evaluation, context or content of EBP educational strategies. The heterogeneity in the reporting of EBP educational interventions makes comparisons between studies difficult. The aim of this program of research is to develop the Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and an accompanying explanation and elaboration (E&E) paper. Methods/design Three stages are planned for the development process. Stage one will comprise a systematic review to identify features commonly reported in descriptions of EBP educational interventions. In stage two, corresponding authors of articles included in the systematic review and the editors of the journals in which these studies were published will be invited to participate in a Delphi process to reach consensus on items to be considered when reporting EBP educational interventions. The final stage of the project will include the development and pilot testing of the GREET statement and E&E paper. Outcome The final outcome will be the creation of a Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and E&E paper. Discussion The reporting of health research including EBP educational research interventions, have been criticised for a lack of transparency and completeness. The development of the GREET statement will enable the standardised reporting of EBP educational research. This will provide a guide for researchers, reviewers and publishers for reporting EBP educational interventions. PMID:23347417
Background Chronic musculoskeletal pain is highly prevalent, affecting around one in five people across Europe. Osteoarthritis, low back pain, neck pain and other musculoskeletal disorders are leading causes of disability worldwide and the most common source of chronic pain. Exercise and/or physical activity interventions have the potential to address not only the pain and disability associated with chronic pain but also the increased risk of morbidity and mortality seen in this population. Although exercise and/or physical activity is widely recommended, there is currently a paucity of research that offers an evidence base upon which the development or optimisation of interventions can be based. This systematic review will investigate the components of interventions associated with changes in physical activity levels in adults with chronic musculoskeletal pain. Methods/Design This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: CENTRAL in the Cochrane Library, the Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two review authors will independently screen articles retrieved from the search for eligibility, extract relevant data on methodological issues and code interventions according to the behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques. As complex healthcare interventions can be modified by a wide variety of factors, data will be summarised statistically when the data are available, are sufficiently similar and are of sufficient quality. A narrative synthesis will be completed if there is insufficient data to permit a formal meta
Kahlert, Daniela; Unyi-Reicherz, Annelie; Stratton, Gareth; Meinert Larsen, Thomas; Fogelholm, Mikael; Raben, Anne; Schlicht, Wolfgang
Background: Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components. Objective: To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach. Methods: The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality. Results: PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major “product” of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and “train-the-trainer” workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people
Corredoira, Eva; Vañó, Eliseo; Alejo, Luis; Ubeda, Carlos; Gutiérrez-Larraya, Federico; Garayoa, Julia
The aim of this study was to assess image quality and radiation dose of a biplane angiographic system with cone-beam CT (CBCT) capability tuned for pediatric cardiac procedures. The results of this study can be used to explore dose reduction techniques. For pulsed fluoroscopy and cine modes, polymethyl methacrylate phantoms of various thicknesses and a Leeds TOR 18-FG test object were employed. Various fields of view (FOV) were selected. For CBCT, the study employed head and body dose phantoms, Catphan 504, and an anthropomorphic cardiology phantom. The study also compared two 3D rotational angiography protocols. The entrance surface air kerma per frame increases by a factor of 3-12 when comparing cine and fluoroscopy frames. The biggest difference in the signal-to- noise ratio between fluoroscopy and cine modes occurs at FOV 32 cm because fluoroscopy is acquired at a 1440 × 1440 pixel matrix size and in unbinned mode, whereas cine is acquired at 720 × 720 pixels and in binned mode. The high-contrast spatial resolution of cine is better than that of fluoroscopy, except for FOV 32 cm, because fluoroscopy mode with 32 cm FOV is unbinned. Acquiring CBCT series with a 16 cm head phantom using the standard dose protocol results in a threefold dose increase compared with the low-dose protocol. Although the amount of noise present in the images acquired with the low-dose protocol is much higher than that obtained with the standard mode, the images present better spatial resolution. A 1 mm diameter rod with 250 Hounsfield units can be distinguished in reconstructed images with an 8 mm slice width. Pediatric-specific protocols provide lower doses while maintaining sufficient image quality. The system offers a novel 3D imaging mode. The acquisition of CBCT images results in increased doses administered to the patients, but also provides further diagnostic information contained in the volumetric images. The assessed CBCT protocols provide images that are noisy, but with
Corredoira, Eva; Vañó, Eliseo; Alejo, Luis; Ubeda, Carlos; Gutiérrez-Larraya, Federico; Garayoa, Julia
The aim of this study was to assess image quality and radiation dose of a biplane angiographic system with cone-beam CT (CBCT) capability tuned for pediatric cardiac procedures. The results of this study can be used to explore dose reduction techniques. For pulsed fluoroscopy and cine modes, polymethyl methacrylate phantoms of various thicknesses and a Leeds TOR 18-FG test object were employed. Various fields of view (FOV) were selected. For CBCT, the study employed head and body dose phantoms, Catphan 504, and an anthropomorphic cardiology phantom. The study also compared two 3D rotational angiography protocols. The entrance surface air kerma per frame increases by a factor of 3-12 when comparing cine and fluoroscopy frames. The biggest difference in the signal-to- noise ratio between fluoroscopy and cine modes occurs at FOV 32 cm because fluoroscopy is acquired at a 1440 × 1440 pixel matrix size and in unbinned mode, whereas cine is acquired at 720 × 720 pixels and in binned mode. The high-contrast spatial resolution of cine is better than that of fluoroscopy, except for FOV 32 cm, because fluoroscopy mode with 32 cm FOV is unbinned. Acquiring CBCT series with a 16 cm head phantom using the standard dose protocol results in a threefold dose increase compared with the low-dose protocol. Although the amount of noise present in the images acquired with the low-dose protocol is much higher than that obtained with the standard mode, the images present better spatial resolution. A 1 mm diameter rod with 250 Hounsfield units can be distinguished in reconstructed images with an 8 mm slice width. Pediatric-specific protocols provide lower doses while maintaining sufficient image quality. The system offers a novel 3D imaging mode. The acquisition of CBCT images results in increased doses administered to the patients, but also provides further diagnostic information contained in the volumetric images. The assessed CBCT protocols provide images that are noisy, but with
Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion
Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have
Background Many children do not meet physical activity (PA) guidelines. Extracurricular programmes could provide a mechanism to increase the PA levels of primary-school-aged children. Teaching assistants (TAs) are a valuable resource in all UK primary schools and could be trained to delivery after-school PA programmes. The aim of this feasibility study is to examine whether the Action 3:30 PA intervention, which is delivered by TAs, could be effective in increasing the PA of Year 5 and 6 children. Methods/Design A feasibility trial will be conducted in 20 primary schools. Schools will be randomly assigned to intervention or control arms. Intervention schools will receive a 25-hour TA training programme for two TAs, a first-aid certificate course for two TAs; ongoing TA support; 40 one-hour session plans that can be delivered by TAs; Action 3:30 clubs that run twice a week for 20 weeks; and ten sets of parent information sheets that are distributed biweekly. All measures will be assessed at baseline (Time 0), at the end of the intervention period (Time 1) and four months after the intervention has ended (Time 2). As this is a feasibility study, our primary interest is in estimating the recruitment of schools and children, adherence to the intervention, and completeness of data collection for outcomes and costs. As the most likely primary outcome measure in a future definitive trial will be accelerometer-determined minutes of moderate-to-vigorous PA (MVPA) per day, participants will wear accelerometers for five days (including two weekend days). Several psychosocial variables that could act as mediators in a future trial will be assessed via a questionnaire. Process evaluations of the session attendance, perceived enjoyment and perceived exertion will be assessed during the intervention. At the end of the intervention period, qualitative assessments will be conducted to identify how the programme could be improved before proceeding to a larger trial. Discussion The
Background Few studies have designed and tested the use of continuous quality improvement approaches in community based substance use treatment settings. Little is known about the feasibility, costs, efficacy, and sustainment of such approaches in these settings. Methods/Design A group-randomized trial using a modified stepped wedge design is being used. In the first phase of the study, eight programs, stratified by modality (residential, outpatient) are being randomly assigned to the intervention or control condition. In the second phase, the initially assigned control programs are receiving the intervention to gain additional information about feasibility while sustainment is being studied among the programs initially assigned to the intervention. Discussion By using this design in a pilot study, we help inform the field about the feasibility, costs, efficacy and sustainment of the intervention. Determining information at the pilot stage about costs and sustainment provides value for designing future studies and implementation strategies with the goal to reduce the time between intervention development and translation to real world practice settings. PMID:24467770
Joske, David; Bulsara, Max; Bulsara, Caroline; Monterosso, Leanne
Introduction Lymphoma is the sixth most common cancer diagnosed in Australia and internationally. Owing to the aggressive nature of the disease and intensity of treatment, survivors face long-term effects that impact on quality of life. Current models of follow-up post-treatment fail to address these complex issues. Given that 74% of patients with lymphoma cancer now survive 5 years beyond diagnosis and treatment, it is important to address this gap in care. Aim To determine self-reported informational and practical needs, anxiety, depression, stress, coping and empowerment at baseline, 3 and 6 months. Methods and analysis A pilot randomised controlled trial will test the effect of a nurse-led lymphoma survivorship clinic compared with usual post-treatment care at a large tertiary cancer centre in Western Australia. The intervention will comprise three face-to-face appointments with delivery of tailored resources, a survivorship care plan and treatment summary (SCP TS). The SCP TS will be given to the participant and general practitioner (GP). Intervention participants will be interviewed at completion to explore the perceived value of the intervention components and preferred dose. An evaluation developed for GPs will assess receipt and use of SCP TS. The primary intent of analysis will be to address the feasibility of a larger trial and requisite effect and sample size. Ethics and dissemination Ethics approval has been granted by the University of Notre Dame Australia and Sir Charles Gairdner Hospital in Western Australia. Peer-reviewed publications and conference presentations will report the results of this phase II trial. Trial registration number ANZCTRN12615000530527; Pre-results. PMID:27194317
Drossaert, Constance HC; Pieterse, Marcel E; Walburg, Jan A; Bohlmeijer, Ernst T
Background Positive psychology interventions have been found to enhance well-being and decrease clinical symptomatology. However, it is still unknown how flourishing can also be increased. Although multicomponent interventions seem to be necessary for this purpose, different formats can be used. A cost-effective approach could be a positive psychology-based self-help book with tailored email support to reach large target groups and to prevent dropout. Objective This study will evaluate the efficacy of a comprehensive multicomponent self-help intervention with or without email support on well-being and flourishing, and will seek to determine the working mechanisms underlying the intervention. Methods In this 3-armed, parallel, randomized controlled trial, 396 participants with low or moderate levels of well-being and without clinical symptomatology will be randomly assigned to (1) a self-help book condition with weekly email support, (2) a self-help book condition without email support but with a weekly information email, or (3) a waiting list control condition. Online measurements will be assessed at baseline, at post-test (3 months after baseline), and at 6 and 12 months after baseline. Results The primary outcomes are well-being and flourishing (ie, high levels of well-being). Secondary outcomes are the well-being components included in the intervention: positive emotion, use of strengths, optimism, self-compassion, resilience, and positive relations. Other measures include depressive and anxiety symptoms, personality traits, direct medical and non-medical costs, life-events, and client satisfaction. Conclusions This study will add knowledge to the efficacy and cost-effectiveness of a multicomponent positive psychology intervention. We will also explore who can benefit most from this intervention. If the intervention is found to be effective, our results will be especially relevant for public mental health services, governments, and primary care. Trial
Akbaş, Meltem; Oztunç, Gürsel
Pain is a concept that goes back into distant history and is something that is faced by every person in different degrees and at different times in their lives. A definition of pain, adopted by the International Association for the Study of Pain and the American Pain Society, is: "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Although pain is one of the most common reasons for needing health care, it is not well understood and continues to be one of the most important health problems today. The pain experience is dynamic, and the nurse is responsible for understanding this. Nurses need to cooperate with the patient and other members of the health care team to be able to control pain. Nurses are ethically responsible for the management and easing of pain. This study was conducted to investigate what nurses know about the care of patients in pain and what nursing actions are used. There were 198 nurses working day shift at Cukurova University Balcali Hospital who were included. The data were collected using a questionnaire that described the nurses and measured the nurses' knowledge about care. The mean age of the nurses was 30.89 years, they had a mean 12.0 years of experience in the profession, 52.0% did not have experience with chronic pain, 42.4% stated that they frequently encountered patients in pain, 70.2% had received education about pain in school, 88.4% had not received education about pain outside of school and did not read about pain in journals, 88.9% used pharmacologic management, 85.4% evaluated patients' pain based on verbal statements, 96.5% knew the important points in the use of opioid analgesics, and 3% knew pain theory. As a result of this study, it is seen that nurses have inadequate knowledge about care of patients in pain and pain control methods. After evaluation of the conclusions, they will be used in education to increase the quality of the nursing
effective strategy for improving collaborative care in the municipalities and health-care professionals’ practice towards elderly patients with depression in primary care. The effectiveness evaluation described in this protocol will be accompanied with a process evaluation exploring why and how the interventions were effective or ineffective. Trial registration ClinicalTrials.gov: NCT01913236 PMID:24405891
Aims To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients. Background There are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders. Design/Methods A mixed methods triangulated convergent design. In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase. Conclusion This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program. PMID:23020906
Protocol for a systematic review of telephone delivered psychosocial interventions on relapse prevention, adherence to psychiatric medication and health risk behaviours in adults with a psychotic disorder
Beck, Alison K; Baker, Amanda; Turner, Alyna; Haddock, Gillian; Kelly, Peter J; Berry, Katherine; Bucci, Sandra
Introduction The mental and physical health of individuals with a psychotic illness are typically poor. When adhered to, medication can reduce relapse. However, despite adherence, relapse remains common and functional outcomes often remain compromised. Compliance is also typically low. Cardiovascular-related morbidity and mortality is also elevated, along with several important modifiable health risk behaviours. Access to psychosocial interventions is therefore important, but currently limited. Telephone delivered interventions represent a promising solution, although further clarity is needed. Accordingly, we aim to provide an overview and critical analysis of the current state of evidence for telephone delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (1) relapse, (2) adherence to psychiatric medication and/or (3) modifiable cardiovascular health risk behaviours. Methods and analysis Our methods are informed by published guidelines. The review is registered and any protocol amendments will be tracked. Ten electronic peer-reviewed and four grey literature databases have been identified. Preliminary searches have been conducted for literature on psychosocial telephone interventions targeting relapse, medication adherence and/or health risk behaviours in adults with a psychotic disorder. Articles classified as ‘evaluation’ will be assessed against standardised criteria and checked by an independent assessor. The searches will be re-run just before final analyses and further studies retrieved for inclusion. A narrative synthesis will be reported, structured around intervention type and content, population characteristics and outcomes. Where possible, ‘summary of findings’ tables will be generated for each comparison. For the primary outcome of each trial, when data are available, we will calculate a risk ratio and its 95% CI (dichotomous outcomes) and/or effect size according to Cohen's formula
Sereda, Magdalena; Coulson, Neil; Hoare, Derek J
Background Tinnitus is a common medical symptom that can affect an individual’s emotional and functional quality of life. Psychological therapies are acknowledged as beneficial to people with tinnitus; however, such therapies are not always readily accessible. With their global reach, automated Internet-based interventions have the potential to reduce the disparity in access to psychological support that people with tinnitus currently experience. However, the evidence on the acceptability and efficacy of these interventions is lacking. Process evaluations that develop an in-depth understanding of how users experience these interventions provide an essential first step when evaluating complex psychological interventions. Objective To describe the protocol for a study that will explore past, current, and new users’ reactions to and interactions with the Tinnitus E-Programme, an Internet-based intervention for the self-management of tinnitus. Methods Two parallel mixed-methods studies will be carried out with 2 different populations. Study 1 will use an online survey to gather past and current users’ views of the program. Study 2 will recruit new program users to take part in an interview and complete a relaxation log to explore how well they were able to implement the skills they learned during the program in their everyday lives. The findings from both studies will be triangulated to develop an in-depth understanding of the program’s mechanisms of impact and identify any implementation or contextual factors that strengthen or impede its delivery and functioning. Results Study 1 is open for recruitment with a projected completion in June 2016 and Study 2 was completed November 2015. At the time of submission, 36 participants have been recruited to Study 1 and 12 participants have taken part in Study 2. Conclusions Findings will inform the optimization of the Tinnitus E-Programme and guide future evaluation work to assess the program’s effectiveness as a
Smaldone, Arlene; Findley, Sally; Bakken, Suzanne; Matiz, L. Adriana; Rosenthal, Susan L.; Jia, Haomiao; Matos, Sergio; Manwani, Deepa; Green, Nancy S.
Background Community health workers (CHW) are increasingly recognized as a strategy to improve health outcomes for the underserved with chronic diseases but has not been formally explored in adolescents with sickle cell disease (SCD). SCD primarily affects African American, Hispanic and other traditionally underserved populations. Hydroxyurea (HU), an oral, once-daily medication, is the only approved therapeutic drug for sickle cell disease and markedly reduces symptoms, morbidity and mortality and improves quality of life largely by increasing hemoglobin F blood levels. This paper presents the rationale, study design and protocol for an open label randomized controlled trial to improve parent-youth partnerships in self-management and medication adherence to HU in adolescents with SCD. Methods/Design A CHW intervention augmented by text messaging was designed for adolescents with SCD ages 10–18 years and their parents to improve daily HU adherence. Thirty adolescent parent dyads will be randomized with 2:1 intervention group allocation. Intervention dyads will establish a relationship with a culturally aligned CHW to identify barriers to HU use, identify cues to build a habit, and develop a dyad partnership to improve daily HU adherence and achieve their individualized “personal best” hemoglobin F target. Intervention feasibility, acceptability and efficacy will be assessed via a 2-site trial. Outcomes of interest are HU adherence, dyad self-management communication, quality of life, and resource use. Discussion Despite known benefits, poor HU adherence is common. If feasible and acceptable, the proposed intervention may improve health of underserved adolescents with SCD by enhancing long-term HU adherence. PMID:27327779
Background The speeding increase and the high prevalence of childhood obesity is a serious problem for Public Health. Community Based Interventions has been developed to combat against the childhood obesity epidemic. However little is known on the efficacy of these programs. Therefore, there is an urgent need to determine the effect of community based intervention on changes in lifestyle and surrogate measures of adiposity. Methods/design Parallel intervention study including two thousand 2249 children aged 8 to 10 years ( 4th and 5th grade of elementary school) from 4 Spanish towns. The THAO-Child Health Program, a community based intervention, were implemented in 2 towns. Body weight, height, and waist circumferences were measured. Children recorded their dietary intake on a computer-based 24h recall. All children also completed validated computer based questionnaires to estimate physical activity, diet quality, eating behaviors, and quality of life and sleep. Additionally, parental diet quality and physical activity were assessed by validated questionnaires. Discussion This study will provide insight in the efficacy of the THAO-Child Health Program to promote a healthy lifestyle. Additionally it will evaluate if lifestyle changes are accompanied by favorable weight management. Trial registration Trial Registration Number ISRCTN68403446 PMID:25174356
Breslin, Gavin; Brennan, Deirdre
We describe the design of a school-based healthy lifestyle intervention for eight-year-old to nine-year-old school children from lower socio-economic backgrounds, intended to increase physical activity, decrease sedentary behaviours, reduce screen-time behaviours, encourage healthy attitudes and behaviours to nutrition, and reduce body mass index.…
McGillivray, Jane A.; Kershaw, Mavis M.
It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body…
Mc Sharry, Jenny; Casey, Dympna; Doherty, Sally; Gillespie, Paddy; Jaarsma, Tiny; Murphy, Andrew W; Newell, John; O'Donnell, Martin; Steinke, Elaine E; Toomey, Elaine; Byrne, Molly
Introduction Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. Methods and analysis This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via
Hoben, Matthias; Kent, Angelle; Kobagi, Nadia; Yoon, Minn N
Introduction Oral healthcare in nursing homes is less than optimal, with severe consequences for residents' health and quality of life. To provide the best possible oral healthcare to nursing home residents, care providers need strategies that have been proven to be effective. Strategies can either encourage and motivate residents to perform oral healthcare themselves or can prevent or overcome responsive behaviours from residents when care providers assist with oral healthcare. This systematic review aims to identify studies that evaluate the effectiveness of such strategies and to synthesise their evidence. Methods and analysis We will conduct a comprehensive search in the databases MEDLINE, EMBASE, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL and Web of Science for quantitative intervention studies that assess the effectiveness of eligible strategies. 2 reviewers will independently screen titles, abstracts and retrieved full texts for eligibility. In addition, contents of key journals, publications of key authors and reference lists of all studies included will be searched by hand and screened by 2 reviewers. Discrepancies at any stage of the review process will be resolved by consensus. Data extraction will be performed by 1 research team member and checked by a second team member. 2 reviewers will independently assess methodological quality of studies included using 3 validated checklists appropriate for different research designs. We will present a narrative synthesis of study results. Ethics and dissemination We did not seek ethics approval for this study, as we will not collect primary data and data from studies included cannot be linked to individuals or organisations. We will publish findings of this review in a peer-reviewed paper and present them at an international peer-reviewed conference. Trial registration number CRD42015026439. PMID:27013601
Background Breastfeeding has countless benefits to mothers, children and community at large, especially in developing countries. Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates. Evidence reveals that antenatal breastfeeding education, professional lactation support, and peer lay support are individually effective at increasing breastfeeding duration and exclusivity, particularly in low-income settings. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon, we hypothesize that a complex breastfeeding support intervention, which is centered on the three components mentioned above, would significantly increase breastfeeding rates. Methods/Design A multi-center randomized controlled trial. Study population: 443 healthy pregnant women in their first trimester will be randomized to control or intervention group. Intervention: A “prenatal/postnatal” professional and peer breastfeeding support package continuing till 6 months postpartum, guided by the Social Network and Social Support Theory. Control group will receive standard prenatal and postnatal care. Mothers will be followed up from early pregnancy till five years after delivery. Outcome measures: Total and exclusive breastfeeding rates, quality of life at 1, 3 and 6 months postpartum, maternal breastfeeding knowledge and attitudes at 6 months postpartum, maternal exclusive breastfeeding rates of future infants up to five years from baseline, cost-benefit and cost-effectiveness analyses of the intervention. Statistical analysis: Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS. Discussion Exclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality. In a country with limited healthcare resources like Lebanon, developing an effective breastfeeding promotion and support intervention that is
Yun, O Bok; Kim, Shin-Jeong; Jung, Dukyoo
This study examined the effects of a clown-nurse educational intervention on children undergoing day surgery for strabismus. This was a quasi-experimental study, using a nonequivalent control group, non-synchronized design. Fifty preschool children and their parents were invited to participate. The children in the intervention group (n=23) received clown therapy and subsequently reported significantly lower states of physiological anxiety, which was evidenced by systolic blood pressure, standardized behavioral anxiety tests, and post-surgery pain, than the control group (n=27). In addition, the parents in the experimental group showed a low state of physiological anxiety, evidenced by systolic blood pressure, pulse rates, standardized behavioral anxiety tests, and state-trait anxiety. The use of preoperative clown intervention may alleviate postoperative problems, not only for children, but also for their parents. PMID:25882469
Yun, O Bok; Kim, Shin-Jeong; Jung, Dukyoo
This study examined the effects of a clown-nurse educational intervention on children undergoing day surgery for strabismus. This was a quasi-experimental study, using a nonequivalent control group, non-synchronized design. Fifty preschool children and their parents were invited to participate. The children in the intervention group (n=23) received clown therapy and subsequently reported significantly lower states of physiological anxiety, which was evidenced by systolic blood pressure, standardized behavioral anxiety tests, and post-surgery pain, than the control group (n=27). In addition, the parents in the experimental group showed a low state of physiological anxiety, evidenced by systolic blood pressure, pulse rates, standardized behavioral anxiety tests, and state-trait anxiety. The use of preoperative clown intervention may alleviate postoperative problems, not only for children, but also for their parents.
Hamilton, Fiona L; Lau, Rosa; Webster, Rosie; Michie, Susan; Murray, Elizabeth
Background Digital interventions provide effective and potentially cost-effective models for improving health outcomes as they deliver health information and services that are widely disseminated, confidential, and can be tailored to needs of the individual user. Digital interventions have been used successfully for health promotion, mental health, and for enabling self-management of long-term conditions. However, their effectiveness is limited by low usage rates, with non-engagement a major challenge. Hence, it is crucial to find effective strategies to increase user engagement with digital interventions. Objective This systematic review will aim to evaluate the effectiveness of technology-based strategies to promote engagement with digital interventions. Methods We will follow Cochrane Collaboration guidelines on systematic review methodology. The search strategy will be executed across seven e-databases (including MEDLINE, EMBASE, PsycINFO, CINAHL) using the concepts “digital intervention” and “engagement”, limited by study type (randomized controlled trial). Grey literature and reference lists of included studies will be searched. Titles and abstracts will be independently screened by 2 authors. Then the full text of potentially eligible papers will be obtained and double screened. Data from eligible papers will be extracted by 1 author and checked for accuracy by another author. Bias will be assessed using the Cochrane bias assessment tool. Narrative synthesis will report on all included studies, and where appropriate, data will be pooled using meta-analysis. All findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sources of heterogeneity will be further investigated if required. Results Our research is in progress. The final draft of the systematic review is being written and will be submitted before the end of 2015. Conclusions The review findings will inform researchers and
Background There is increasing community and government recognition of the magnitude and impact of adolescent depression. Family based interventions have significant potential to address known risk factors for adolescent depression and could be an effective way of engaging adolescents in treatment. The evidence for family based treatments of adolescent depression is not well developed. The objective of this clinical trial is to determine whether a family based intervention can reduce rates of unipolar depressive disorders in adolescents, improve family functioning and engage adolescents who are reluctant to access mental health services. Methods/Design The Family Options study will determine whether a manualized family based intervention designed to target both individual and family based factors in adolescent depression (BEST MOOD) will be more effective in reducing unipolar depressive disorders than an active (standard practice) control condition consisting of a parenting group using supportive techniques (PAST). The study is a multicenter effectiveness randomized controlled trial. Both interventions are delivered in group format over eight weekly sessions, of two hours per session. We will recruit 160 adolescents (12 to 18 years old) and their families, randomized equally to each treatment condition. Participants will be assessed at baseline, eight weeks and 20 weeks. Assessment of eligibility and primary outcome will be conducted using the KID-SCID structured clinical interview via adolescent and parent self-report. Assessments of family mental health, functioning and therapeutic processes will also be conducted. Data will be analyzed using Multilevel Mixed Modeling accounting for time x treatment effects and random effects for group and family characteristics. This trial is currently recruiting. Challenges in design and implementation to-date are discussed. These include diagnosis and differential diagnosis of mental disorders in the context of adolescent
Jahn, Patrick; Kuss, Oliver; Schmidt, Heike; Bauer, Alexander; Kitzmantel, Maria; Jordan, Karin; Krasemann, Susann; Landenberger, Margarete
Patients' self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients' barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain>3 days, and average pain > or = 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire-BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was -0.49 points (95% confidence interval -0.87 points to -0.12 points; P=0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66-44.40; P=0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients' self-management of cancer pain.
Chen, Xiaofen; Chen, Weiting; Hu, Weijie; Huang, Kui; Huang, Jing; Zhou, Yu
Background Continuous positive airway pressure (CPAP) is widely recommended for the treatment of sleep apnea/hypopnea syndrome (SAHS), but its usage by patients is very low. The aim of this study was to assess intensive educational programs and nursing support for the improvement of CPAP use and outcomes in SAHS patients. Methods Eighty new SAHS patients were randomized to receive nurse-led intensive interventions or usual support at hospital and home. The main outcome measure was CPAP use; changes in sleeping, symptoms, mood, and quality of life were also assessed after 12 months of treatment. Results All outcome measures were improved after treatment in both groups. However, patients receiving intensive support with significantly higher CPAP use (higher daily CPAP usage by 2.2 hours/day) had greater improvements in SAHS symptoms and mood (P<0.05). The intervention group further showed an improvement in the Short Form-36 domains of mental and physical health (P<0.05). Conclusion The CPAP usage and quality of life can be significantly improved by nurse-led intensive program in obstructive sleep apnea patients. PMID:26648703
Collie, Alex; Gabbe, Belinda; Fitzharris, Michael
Introduction Injuries resulting from road traffic crashes are a substantial cause of disability and death worldwide. Injured persons receiving compensation have poorer recovery and return to work than those with non-compensable injury. Case or claims management is a critical component of injury compensation systems, and there is now evidence that claims management can have powerful positive impacts on recovery, but can also impede recovery or exacerbate mental health concerns in some injured people. This study seeks to evaluate the impact of a population-based injury claims management intervention in the State of Victoria, Australia, on the health of those injured in motor vehicle crashes, their experience of the compensation process, and the financial viability of the compensation system. Methods and analysis Evaluation of this complex intervention involves a series of linked but stand-alone research projects to assess the anticipated process changes, impacts and outcomes of the intervention over a 5-year time frame. Linkage and analysis of routine administrative and health system data is supplemented with a series of primary studies collecting new information. Additionally, a series of ‘action’ research projects will be undertaken to inform the implementation of the intervention. A program logic model designed by the state government Transport Accident Commission in conjunction with the research team provides the evaluation framework. Ethics and dissemination Relatively few studies have comprehensively examined the impact of compensation system processes on the health of injured persons, their satisfaction with systems processes, and impacts on the financial performance of the compensation scheme itself. The wholesale, population-based transformation of an injury claims management model is a rare opportunity to document impacts of system-level policy change on outcomes of injured persons. Findings will contribute to the evidence base of information on the
Bunge, Eduardo L; Barrera, Alinne Z; Wickham, Robert E; Lee, Jessica
Background The Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically to help low-income English- and Spanish-speaking smokers to quit. Individuals from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status. Objective We plan to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public-sector health care system can significantly improve its acceptability, utilization, and effectiveness. Methods Using human-centered development methods, we will involve low-income patients in the design of a Web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will iteratively develop versions of the digital interventions informed by our human-centered approach. The project involves three specific aims: (1) human-centered development of an English/Spanish smoking cessation web app, (2) improvement of dissemination strategies, and (3) evaluation of resulting smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool that is highly responsive to the needs and preferences of the users. Input from participants will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period. We will evaluate the effectiveness of the successive versions of the resulting stop smoking Web app by an online randomized controlled trial. Increased effectiveness will be defined as increased utilization of the Web app and higher abstinence rates than those obtained by a baseline usual care Web app. Results
Background Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women. Methods/design Pregnant women at risk of GDM (BMI≥29 (kg/m2)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, women without GDM will be included (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5 mmol) and randomized to one of the 8 intervention arms using a 2×(2×2) factorial design: (1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating ‘messages’ and/or 5 physical activity ‘messages’ depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24–28 weeks, 35–37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight. Discussion DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women. Trial registration ISRCTN70595832 PMID:23829946
Jahangeer, Saleem; Gardiner, Rebecca Emily; Forde, Patrick; Hinchion, John
Purulent pericarditis is a rare entity in the postantibiotic era. It usually occurs in patients who have underlying chronic and immunosuppressing conditions and its presentation in the healthy adult population is quite rare. Infection of the pericardial space can occur via direct extension from infectious endocarditis, pneumonia, or empyema, or from a more distant source such as meningitis. Purulent pericarditis carries a very high mortality because of delay in the diagnosis and early occurrence of fatal complications. We describe a case of purulent pericarditis with impending cardiac tamponade in a previously healthy 40-year-old female patient, which was successfully treated with a combination of prompt surgical drainage and a novel irrigation protocol. PMID:26693123
Understanding the performance and impact of public knowledge translation funding interventions: Protocol for an evaluation of Canadian Institutes of Health Research knowledge translation funding programs
Background The Canadian Institutes of Health Research (CIHR) has defined knowledge translation (KT) as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities. Design The study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement. Discussion The protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding interventions, and how KT can
Cobb, Nathan K; Jacobs, Megan A; Saul, Jessie; Wileyto, E Paul; Graham, Amanda L
Introduction Online social networks represent a potential mechanism for the dissemination of health interventions including smoking cessation; however, which elements of an intervention determine diffusion between participants is unclear. Diffusion is frequently measured using R, the reproductive rate, which is determined by the duration of use (t), the ‘contagiousness’ of an intervention (β) and a participant's total contacts (z). We have developed a Facebook ‘app’ that allows us to enable or disable various components designed to impact the duration of use (expanded content, proactive contact), contagiousness (active and passive sharing) and number of contacts (use by non-smoker supporters). We hypothesised that these elements would be synergistic in their impact on R, while including non-smokers would induce a ‘carrier’ state allowing the app to bridge clusters of smokers. Methods and analysis This study is a fractional factorial, randomised control trial of the diffusion of a Facebook application for smoking cessation. Participants recruited through online advertising are randomised to 1 of 12 cells and serve as ‘seed’ users. All user interactions are tracked, including social interactions with friends. Individuals installing the application that can be traced back to a seed participant are deemed ‘descendants’ and form the outcome of interest. Analysis will be conducted using Poisson regression, with event count as the outcome and the number of seeds in the cell as the exposure. Results The results will be reported as a baseline R0 for the reference group, and incidence rate ratio for the remainder of predictors. Ethics and Dissemination This study uses an abbreviated consent process designed to minimise barriers to adoption and was deemed to be minimal risk by the Institutional Review Board (IRB). Results will be disseminated through traditional academic literature as well as social media. If feasible, anonymised data and underlying
Background Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen. Methods/Design The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers. MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis. The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design. MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs) are supported in convening monthly women's groups. Nine groups per cluster (270 in total) work through two action research cycles in which they (i) identify local issues around maternity, newborn health and nutrition, (ii) prioritise key problems, (iii) develop strategies to address them, (iv) implement the strategies, and (v) evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i) identify local births, (ii) identify low birth weight infants, (iii) identify possible newborn infection, (iv) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v) follow up infants and support families. Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal diet
Research demonstrated nurses' education needs to be able to document nursing diagnoses, interventions and patient outcomes in the EHR. The aim of this study is to investigate the effect of Guided Clinical Reasoning, a learning method to foster nurses' abilities in using standardized language. In a cluster randomized experimental study, nurses from 3 wards received Guided Clinical Reasoning (GCR), a learning method to foster nurses in stating nursing diagnoses, related interventions and outcomes. Three wards, receiving Classic Case Discussions, functioned as control group. The learning effect was measured by assessing the quality of 225 nursing documentations by applying 18 Likert-type items with a 0-4 scale of the measurement instrument "Quality of Nursing Diagnoses, Interventions and Outcomes" (Q-DIO). T-tests were applied to analyze pre-post intervention scores. GCR led to significantly higher quality of nursing diagnosis documentation; to etiology-specific nursing interventions and to enhanced nursing-sensitive patient outcomes. Before GCR, the pre-intervention mean in quality of nursing documentation was = 2.69 (post-intervention = 3.70; p<.0001). Similar results were found for nursing interventions and outcomes. In the control group, the quality remained unchanged. GCR supported nurses' abilities to state accurate nursing diagnoses, to select effective nursing interventions and to reach enhanced patient outcomes. Nursing diagnoses (NANDA-I) with related interventions and patient outcomes provide a knowledgebase for nurses to use standardized language in the EHR.
Background Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence. Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. Design A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). Method Participants are
Background E-health tools are a new mechanism to expand patient care, allowing supplemental resources to usual care, including enhanced patient-provider communication. These applications to smoking cessation have yet to be tested in a hospitalized patient sample. This project aims to evaluate the effectiveness and cost-effectiveness of a tailored web-based and e-message smoking cessation program for current smokers that, upon hospital discharge, transitions the patient to continue a quit attempt when home (Decide2Quit). Design A randomized two-arm follow-up design will test the effectiveness of an evidence- and theoretically-based smoking cessation program designed for post-hospitalization. Methods A total of 1,488 patients aged 19 or older, who smoked cigarettes in the previous 30 days, are being recruited from 27 patient care areas of a large urban university hospital. Study-eligible hospitalized patients receiving usual tobacco cessation usual care are offered study referral. Trained hospital staff assist the 744 patients who are being randomized to the intervention arm with registration and orientation to the intervention website. This e-mail and web-based program offers tailored messages as well as education, self-assessment and planning aids, and social support to promote tobacco use cessation. Condition-blind study staff assess participants for tobacco use history and behaviors, tobacco use cost-related information, co-morbidities and psychosocial factors at 0, 3, 6, and 12 months. The primary outcome is self-reported 30-day tobacco abstinence at 6 months follow-up. Secondary outcomes include 7-day point prevalence quit rates at 3-, 6-, and 12-month follow-up, 30-day point prevalence quit rates at 3 and 12 months, biologically confirmed tobacco abstinence at 6-month follow-up, and multiple point-prevalence quit rates based on self-reported tobacco abstinence rates at each follow-up time period. Healthcare utilization and quality of life are assessed at
Ramos-Gomez, F J; Crystal, Y O; Domejean, S; Featherstone, J D B
Recent increases in caries prevalence in young children throughout the world highlight the need for a simple but effective infant oral care programme. This programme needs to include a medical disease prevention management model with an early establishment of a dental home and a treatment approach based on individual patient risk. This article presents an updated approach with practical forms and tools based on the principles of caries management by risk assessment, CAMBRA. This method will aid the general practitioner to develop and maintain a comprehensive protocol adequate for infant and young children oral care visits. Perinatal oral health is vitally important in preventing early childhood caries (ECC) in young children. Providing dental treatment to expectant mothers and their young children in a 'dual parallel track' is an effective innovative strategy and an efficient practice builder. It promotes prevention rather than intervention, and this may be the best way to achieve long-lasting oral health for young patients. General dental practice can adopt easy protocols that will promote early preventive visits and anticipatory guidance/counselling rather than waiting for the need for restorative treatment.
Lee, Simon Craddock; Marks, Emily G; Persaud, Donna; Skinner, Celette Sugg; Street, Richard L; Wiebe, Deborah J; Farrell, David; Bishop, Wendy Pechero; Fuller, Sobha; Baldwin, Austin S
Background Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion—generating one’s own arguments for a health behavior—may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Objective Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. Methods In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents’ self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent
Hendricks-Ferguson, Verna L; Kane, Javier R; Pradhan, Kamnesh R; Shih, Chie-Schin; Gauvain, Karen M; Baker, Justin N; Haase, Joan E
When a child's prognosis is poor, physicians and nurses (MDs/RNs) often struggle with initiating discussions about palliative and end-of-life care (PC/EOL) early in the course of illness trajectory. We describe evaluation of training procedures used to prepare MD/RN dyads to deliver an intervention entitled: Communication Plan: Early Through End of Life (COMPLETE) intervention. Our training was delivered to 5 pediatric neuro-oncologists and 8 pediatric nurses by a team of expert consultants (i.e., in medical ethics, communication, and PC/EOL) and parent advisors. Although half of the group received training in a 1-day program and half in a 2-day program, content for all participants included 4 modules: family assessment, goal-directed treatment planning, anticipatory guidance, and staff communication and follow-up. Evaluations included dichotomous ratings and qualitative comments on content, reflection, and skills practice for each module. Positive aspects of our training included parent advisers' insights, emphasis on hope and non-abandonment messages, written materials to facilitate PC/EOL communication, and an MD/RN dyad approach. Lessons learned and challenges related to our training procedures will be described. Overall, the MDs and RNs reported that our PC/EOL communication-training procedures were helpful and useful. Future investigators should carefully plan training procedures for PC/EOL communication interventions.
Hamester, Letícia; de Souza, Emiliane Nogueira; Cielo, Cibele; Moraes, Maria Antonieta; Pellanda, Lúcia Campos
ABSTRACT Objective: to verify the effectiveness of nursing orientation provided to families of patients in the immediate post-operative following cardiac surgery before the first visit to the post-anesthesia care unit, in decreasing anxiety levels, compared to the unit's routine orientation. Method: open randomized clinical trial addressing family members in the waiting room before the first visit in the immediate post-operative period. The family members assigned to the intervention group received audiovisual orientation concerning the patients' conditions at the time and the control group received the unit's routine orientation. Outcome anxiety was assessed using the STAI-State. Results: 210 individuals were included, 105 in each group, aged 46.4 years old on average (±14.5); 69% were female and 41% were the patients' children. The mean score obtained on the anxiety assessment in the intervention group was 41.3±8.6, while the control group scored 50.6±9.4 (p<0.001). Conclusion: a nursing intervention focused on providing guidance to families before their first visit to patients in the immediate post-operative period of cardiac surgery helps to decrease the levels of anxiety of companions, making them feel better prepared for the moment. ReBEC (Brazilian Clinical Trials Registry) and The Universal Trial Number (UTN), No. U1111-1145-6172. PMID:27533263
Background Globally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes. Methods Establishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG). Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral. Implementation: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback. Evaluation: File audits, post workshop questionnaires and semi-structured interviews are administered. Discussion This project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies. PMID:23331868
Background In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life. Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking. Methods/Design A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention. One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included. The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver. The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account. Discussion Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard
Pradhan, Pranil Man Singh; Dhital, Rolina; Subhani, Huma
Introduction Malnutrition among children is a serious public health problem in the aftermath of any natural disaster. We will review the various nutrition interventions for children aged <5 years in countries where natural disasters occurred and analyse the effect on nutrition-related outcomes. Methods and analysis We will conduct a systematic review on nutrition intervention studies following natural disasters that were published between January 2000 and December 2015. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane Risk of Bias (RoB) tool will be used for randomised controlled trials and Risk of Bias Assessment for Non-Randomized Studies (RoBANS) will be used for non-randomised studies. The quality of evidence will be assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. If sufficient data are available, we will conduct meta-analyses to establish the relationship between nutrition interventions and nutrition outcome indicators. All statistical analyses will be performed using Review Manager (Rev Man) V.5.3 for Windows. Heterogeneity of the data will be tested using the standard χ2 test. A fixed-effect model will be used for the studies with high heterogeneity (p value>0.10, I2≤50%). For dichotomous and continuous data, relative risk (RR) and mean difference with 95% CI will be used respectively. Subgroup analysis will be performed for studies with low heterogeneity (p value ≤0.10). We will use Z score with the level of significance set at p value <0.05 to test the total effect. Funnel plots will be used to detect publication bias. Ethics and dissemination As primary data will not be collected, formal ethical approval will not be required. The results will be disseminated by publication in peer-reviewed journals, conference presentations and the media. Registration details International Prospective Register for Systematic
Background Anxiety in children is common and incapacitating and increases the risk of mental health disorders in adulthood. Although effective interventions are available, few children are identified and referred for specialist treatment. Alternative approaches in which prevention programmes are delivered in school appear promising. However, comparatively little is known about the best intervention leader (health care–led vs. school-led), long-term effects or the primary preventive value of such programmes. Methods/Design Preventing Anxiety in Children through Education in Schools, or PACES, is a pragmatic cluster randomised controlled trial evaluating the effectiveness of a cognitive-behavioural therapy prevention programme (FRIENDS) on symptoms of anxiety and low mood in 9- to 10-year-old children. Forty-one schools were randomly assigned to one of three conditions: school-led FRIENDS, health care–led FRIENDS or treatment as usual. Assessments were undertaken at baseline, 6 months and 12 months, with the primary outcome measure being the Revised Child Anxiety and Depression Scale score at 12 months. Secondary outcome measures are changes in self-esteem, worries, bullying and life satisfaction. Discussion This protocol summarises the procedure for the 24-month follow-up of this cohort. The study will determine the medium-term effectiveness of an anxiety prevention programme delivered in schools. Trial registration ISRCTN23563048 PMID:24624990
Himaj, J; Müller, E; Fey, B; Neumaier, S; Waibel, B; Dirschedl, P; Wallesch, C W
The German DRG system defines specialized treatments through a set of minimal requirements, the documentation of which and its assessment by external specialists of the medical service of the statutory health insurance causing frictions between rehabilitation hospitals and the medical service. It is especially problematic to make a clear distinction between nursing care and treatment. To reduce frictions and interface problems, a catalogue of acts of therapy performed by nurses was agreed for neurological early rehabilitation in Baden-Württemberg. This Elzach concept and catalogue describe therapeutic nursing in neurological rehabilitation and increase transparency and accountability both for providers and cost carriers.
Low, Lee-Fay; Brodaty, Henry; Goodenough, Belinda; Spitzer, Peter; Bell, Jean-Paul; Fleming, Richard; Casey, Anne-Nicole; Liu, Zhixin; Chenoweth, Lynn
Objectives To determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents. Design The Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a single-blind cluster randomised controlled trial of humour therapy. Setting 35 Sydney nursing homes. Participants All eligible residents within geographically defined areas within each nursing home were invited to participate. Intervention Professional ‘ElderClowns’ provided 9–12 weekly humour therapy sessions, augmented by resident engagement by trained staff ‘LaughterBosses’. Controls received usual care. Measurements Depression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment. Randomisation Sites were stratified by size and level of care then assigned to group using a random number generator. Results Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0
van Esch, Babette F; van der Zaag-Loonen, Hester J; Bruintjes, Tjasse D; van Benthem, Peter Paul G
Introduction The large number of treatment modalities for patients diagnosed with Menière's disease (MD) complicates the selection of the best available treatment as the comparative efficacy of these interventions is not clear. We aim to identify the treatment or treatments with the highest efficacy of current pharmacological and non-pharmacological treatments for MD. Methods and analysis We will identify all available systematic reviews on the treatment of MD. An online database search will be conducted in association with the UK Cochrane Centre, particularly the Ear, Nose and Throat Group. We will screen the systematic reviews for eligible randomised controlled trials (RCTs) to execute a network meta-analysis. In addition, online databases will be checked for eligible RCTs on treatments that were published after the latest systematic search was conducted. The characteristics of each RCT will be summarised, including the general design, the participants, the interventions, the outcome measurements, the duration of therapy and adverse events. The risk of bias will be assessed by means of the Cochrane Collaboration's risk of bias tool. The included studies will be assessed for methodological and statistical heterogeneity; the latter will be quantified by means of the I2 statistic. The primary outcome will be the efficacy of treatment in terms of control of vertigo attacks. Secondary outcome measures will be the loss or improvement of hearing, severity of vertigo attacks and tinnitus, perception of aural fullness, quality of life, and the incidence of adverse events and complications. Ethics and dissemination Formal ethical approval is not required as primary data will not be collected. The review will be disseminated in peer-reviewed publications and conference presentations. PROSPERO registration number CRD42015024243. PMID:27288370
Background Poor adherence to medication is one of the limitations in the treatment of cardiovascular diseases, thereby increasing the risk of premature death, hospital admissions, and related costs. There is a need for simple and easy-to-implement interventions that are based on patients’ perspectives, beliefs, and perceptions of their illness and medication. Objective The objective is to test the effectivity of this intervention to improve medication adherence in patients with established cardiovascular disease, that is, in secondary prevention. Methods In this study the effect of a personalized visualization of cardiovascular risk levels through a website aiming at supporting self management in combination with a group consultation and communication intervention by a nurse on adherence to treatment in 600 patients with manifest cardiovascular diseases will be assessed. The health belief model was chosen as main theoretical model for the intervention. Results Primary outcome is adherence to treatment calculated by refill data. Secondary outcomes include the Beliefs about Medication Questionnaire and the Modified Morisky Scale. Patients are followed for one year. Results are expected by 2015. Conclusions This study assesses adherence to treatment in a high-risk cardiovascular population by applying an intervention that addresses patients’ capacity and practical barriers as well as patients’ beliefs and perceptions of their illness and medication. ClinicalTrial ClinicalTrials.gov NCT01449695; https://clinicaltrials.gov/ct2/show/NCT01449695 (Archived by WebCite at http://www.webcitation.org/6kCzkIKH3) PMID:27624877
Background Weight loss in overweight or obese breast cancer patients is associated with an improved prognosis for long term survival. However, it is not clear whether the macronutrient composition of the chosen weight loss dietary plan imparts further prognostic benefit. A study protocol is presented for a dietary intervention to investigate the effects of weight loss dietary patterns that vary markedly in fat and carbohydrate contents on biomarkers of exposure to metabolic processes that may promote tumorigenesis and that are predictive of long term survival. The study will also determine how much weight must be lost for biomarkers to change in a favorable direction. Methods/Design Approximately 370 overweight or obese postmenopausal breast cancer survivors (body mass index: 25.0 to 34.9 kg/m2) will be accrued and assigned to one of two weight loss intervention programs or a non-intervention control group. The dietary intervention is implemented in a free living population to test the two extremes of popular weight loss dietary patterns: a high carbohydrate, low fat diet versus a low carbohydrate, high fat diet. The effects of these dietary patterns on biomarkers for glucose homeostasis, chronic inflammation, cellular oxidation, and steroid sex hormone metabolism will be measured. Participants will attend 3 screening and dietary education visits, and 7 monthly one-on-one dietary counseling and clinical data measurement visits in addition to 5 group visits in the intervention arms. Participants in the control arm will attend two clinical data measurement visits at baseline and 6 months. The primary outcome is high sensitivity C-reactive protein. Secondary outcomes include interleukin-6, tumor necrosis factor-α, insulin-like growth factor-1 (IGF), IGF binding protein-3, 8-isoprostane-F2-alpha, estrone, estradiol, progesterone, sex hormone binding globulin, adiponectin, and leptin. Discussion While clinical data indicate that excess weight for height is associated
Simpson, Sharon A; Butler, Christopher C; Hood, Kerry; Cohen, David; Dunstan, Frank; Evans, Meirion R; Rollnick, Stephen; Moore, Laurence; Hare, Monika; Bekkers, Marie-Jet; Evans, John
Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning) called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not) and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include feedback of practice level data
Background Mid to late adolescence is characterised by a vulnerability to problematic substance use since the consumption of alcohol and illicit drugs is frequently initiated and increased in this life period. While the detrimental long- and short-term effects of problematic consumption patterns in adolescence pose a major public health concern, current prevention programs targeting alcohol- and other substance-using adolescents are scarce. The study described in this protocol will test the effectiveness of a web-based brief intervention aimed at reducing problematic alcohol use and promoting abstinence from illegal drugs in adolescents with risky substance use aged 16 to 18 years old in four EU-countries. Methods/design To determine the effectiveness of our web-BI, we apply a two-arm randomized controlled trial (RCT) study design, with baseline assessment at study entry and a three month follow-up assessment. Adolescents aged 16 to 18 years from Belgium, the Czech Republic, Germany, and Sweden will be randomly assigned to either the fully electronically delivered brief intervention group (N = 400) or an assessment only control group (N = 400) depending on their screening for risky substance use (using the CRAFFT). Recruitment, informed consent, randomization, intervention and follow-up will be implemented online. Primary outcomes are reductions in frequency and quantity of use of alcohol and drugs other than alcohol over a 30 day period, as well as consumption per typical occasion. Secondary outcomes concern changes in substance use related cognitions including the constructs of the Theory of Planned Behaviour, implementation intentions, and stages of change. Moreover the study addresses a number of moderator variables, including age of first use, general psychopathology and quality of parent–child relationship. Discussion The trial is expected to contribute to the growing literature on theory- and web-based brief interventions for adolescents. We will
Blaufuss, J; Wynn, J; Hujcs, M
Computerization of these protocols is in progress. This project is funded for one year with projected completion in January 1994. This study will form a framework in which further research can be completed. Utilizing protocols will allow the measurement of nursing decision making by testing relationships between parameters and interventions and by identifying rules for decision making. For example, questions that may be answered include which physiologic parameters do clinicians treat and in what order or priority, as well as what is the impact on patient outcomes in regard to cost of care and complications. Computerized patient care protocols can be further developed to meet patient-specific needs. A computerized data base will facilitate managing large amounts of patient data and tailoring instructions to these patients. One of the goals of this project was to measure the feasibility of developing computerized patient care protocols and implementing them in a critical care setting. Eventually, this experience will facilitate implementing computerized protocols at other sites. An additional benefit is the ability to implement continuous quality improvement strategies in a prospective manner rather than by retrospective review. PMID:10171735
Friedmann, Peter D; Ducharme, Lori J; Welsh, Wayne; Frisman, Linda; Knight, Kevin; Kinlock, Timothy; Mitchell, Shannon Gwin; Hall, Elizabeth; Urbine, Terry; Gordon, Michael; Abdel-Salam, Sami; O'Connell, Dan; Albizu-Garcia, Carmen; Knudsen, Hannah; Duval, Jamieson; Fenster, Juliane
Background Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services. Methods/design Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two
Background Chronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population. Medication overuse contributes to the problem. Medication-overuse headache (MOH) can be identified by using the Severity of Dependence Scale (SDS). A “brief intervention” scheme (BI) has previously been used for detoxification from drug and alcohol overuse in other settings. Short, unstructured, individualised simple information may also be enough to detoxify a large portion of those with MOH. We have adapted the structured (BI) scheme to be used for MOH in primary care. Methods/Design A double-blinded cluster randomised parallel controlled trial (RCT) of BI vs. business as usual. Intervention will be performed in primary care by GPs trained in BI. Patients with MOH will be identified through a simple screening questionnaire sent to patients on the GPs lists. The BI method involves an approach for identifying patients with high likelihood of MOH using simple questions about headache frequency and the SDS score. Feedback is given to the individual patient on his/her score and consequences this might have regarding the individual risk of medication overuse contributing to their headache. Finally, advice is given regarding measures to be taken, how the patient should proceed and the possible gains for the patient. The participating patients complete a headache diary and receive a clinical interview and neurological examination by a GP experienced in headache diagnostics three months after the intervention. Primary outcomes are number of headache days and number of medication days per month at 3 months. Secondary outcomes include proportions with 25 and 50% improvement at 3 months and maintenance of improvement and quality of life after 12 months. Discussion There is a need for evidence-based and cost-effective strategies for treatment of MOH but so far no consensus has been reached regarding an optimal medication withdrawal method. To our
Pellico, Linda Honan; Duffy, Thomas C; Fennie, Kristopher P; Swan, Katharine A
Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p < .0001). The ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50 percent; and bowel sounds interpretation improved threefold, demonstrating the effect of an adult-oriented, creative, yet practical method for teaching auscultation.
van Hezel, Sanne; de Boer, Angela GEM; Frings-Dresen, Monique HW
Background It is important to enhance the return to work of cancer survivors with an appropriate intervention, as cancer survivors experience problems upon their return to work but consider it an essential part of their recovery. Objective The objective of our study was to develop an eHealth intervention to enhance the return to work of cancer survivors and to test the feasibility of the eHealth intervention with end users. Methods To develop the intervention we 1) searched the literature, 2) interviewed 7 eHealth experts, 3) interviewed 7 cancer survivors, 2 employers, and 7 occupational physicians, and 4) consulted experts. To test feasibility, we enrolled 39 cancer survivors, 9 supervisors, 7 occupational physicians, 9 general physicians and 2 social workers and gave them access to the eHealth intervention. We also interviewed participants, asked them to fill in a questionnaire, or both, to test which functionalities of the eHealth intervention were appropriate and which aspects needed improvement. Results Cancer survivors particularly want information and support regarding the possibility of returning to work, and on financial and legal aspects of their situation. Furthermore, the use of blended care and the personalization of the eHealth intervention were preferred features for increasing compliance. The first version of the eHealth intervention consisted of access to a personal and secure website containing various functionalities for cancer survivors blended with support from their specialized nurse, and a public website for employers, occupational physicians, and general physicians. The eHealth intervention appeared feasible. We adapted it slightly by adding more information on different cancer types and their possible effects on return to work. Conclusions A multistakeholder and mixed-method design appeared useful in the development of the eHealth intervention. It was challenging to meet all end user requirements due to legal and privacy constraints. The e
Randall, T.M.; Drake, D.K.; Sewchand, W.
Radiation control and safety are major considerations for nursing personnel during the care of patients receiving brachytherapy. Since the theory and practice of radiation applications are not part of the routine curriculum of nursing programs, the education of nurses and other health care professionals in radiation safety procedures is important. Regulatory agencies recommend that an annual safety course be given to all persons frequenting, using, or associated with patients containing radioactive materials. This article presents pertinent aspects of the principles and procedures of radiation safety, the role of personnel dose-monitoring devices, and the value of additional radiation control features, such as a lead cubicle, during interstitial brain implants. One institution's protocol and procedures for the care of high-intensity iridium-192 brain implants are discussed. Preoperative teaching guidelines and nursing interventions included in the protocol focus on radiation control principles.
Magan Mendoza, Yimdriuska; Rosenthal, Jaime; Jacolbia, Ronald; Rajkomar, Alvin; Lee, Herman; Auerbach, Andrew
Background Inadequate patient engagement in care is a major barrier to successful transitions from the inpatient setting and can lead to preventable adverse events after discharge, particularly for older adults. While older adults may be less familiar with mobile devices and applications, they may benefit from focused bedside training to engage them in using their Personal Health Record (PHR). Mobile technologies such as tablet computers can be used in the hospital to help bridge this gap in experience by teaching older, hospitalized patients to actively manage their medication list through their PHR during hospitalization and continue to use their PHR for other post-discharge tasks such as scheduling follow-up appointments, viewing test results, and communicating with providers. Bridging this gap is especially important for older, hospitalized adults as they are at higher risk than younger populations for low engagement in transitions of care and poor outcomes such as readmission. Greater understanding of the advantages and limitations of mobile devices for older adults may be important for improving transitions of care. Objective To better understand the effective use of mobile technologies to improve transitions in care for hospitalized, older adults and leverage these technologies to improve inpatient and postdischarge care for older adults. Methods We will compare an intervention group with tablet-based training to engage effectively with their PHR to a control group also receiving tablets and basic access to their PHR but no additional training on how to engage with their PHR. Results Patient enrollment is ongoing. Conclusions Through this grant, we will further develop our preliminary dataset and practical experience with these mobile technologies to catalyze patient engagement during hospitalization. ClinicalTrial ClinicalTrials.gov NCT02109601; https://clinicaltrials.gov/ct2/show/NCT02109601 (Archived by WebCite at http://www.webcitation.org/6jpXjkwM8
Bravo, Katherine; Cochran, Gary; Barrett, Ryan
Using data obtained through 2 multidisciplinary studies focused on medication safety effectiveness, this article provides nursing recommendations to decrease medication delivery errors. Strategies to minimize and address interruptions/distractions are proposed for the 3 most problematic time frames in which medication errors typically arise: medication acquisition, transportation, and bedside delivery. With planned interventions such as programmed scripts and hospital-based protocols to manage interruptions and distractions, patient safety can be maintained in the inpatient setting.
The Health and Sport Engagement (HASE) Intervention and Evaluation Project: protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity
Mansfield, Louise; Anokye, Nana; Fox-Rushby, Julia; Kay, Tess
Introduction Sport is being promoted to raise population levels of physical activity for health. National sport participation policy focuses on complex community provision tailored to diverse local users. Few quality research studies exist that examine the role of community sport interventions in raising physical activity levels and no research to date has examined the costs and cost-effectiveness of such provision. This study is a protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity, the Health and Sport Engagement (HASE) project part of the national Get Healthy Get Active programme led by Sport England. Methods and analysis The HASE study is a collaborative partnership between local community sport deliverers and sport and public health researchers. It involves designing, delivering and evaluating community sport interventions. The aim is to engage previously inactive people in sustained sporting activity for 1×30 min a week and to examine associated health and well-being outcomes. The study uses mixed methods. Outcomes (physical activity, health, well-being costs to individuals) will be measured by a series of self-report questionnaires and attendance data and evaluated using interrupted time series analysis controlling for a range of sociodemographic factors. Resource use will be identified and measured using diaries, interviews and records and presented alongside effectiveness data as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. A longitudinal process evaluation (focus groups, structured observations, in-depth interview methods) will examine the efficacy of the project for achieving its aim using the principles of thematic analysis. Ethics and dissemination The results of this study will be disseminated through peer-reviewed publications, academic conference presentations, Sport England and national public health organisation
Veettil, Sajesh K.; Saokaew, Surasak; Lim, Kean Ghee; Ching, Siew Mooi; Phisalprapa, Pochamana
Background Colorectal cancer (CRC) is the third most common cancer worldwide and is associated with substantial socioeconomic burden. Despite considerable research, including numerous randomised controlled trials (RCTs) and systematic reviews assessed the effect of various chemopreventive interventions for CRC, there remains uncertainty regarding the comparative effectiveness of these agents. No network meta-analytic study has been published to evaluate the efficacies of these agents for CRC. Therefore, the aim of this study is to summarise the direct and indirect evidence for these interventions to prevent CRC in average-high risk individuals, and to rank these agents for practical consideration. Methods We will acquire eligible studies through a systematic search of MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, CINAHL plus, IPA and clinicaltrials.gov website. The Cochrane Risk of Bias Tool will be used to assess the quality of included studies. The primary outcomes are the incidence of CRC, the incidence/recurrence of any adenoma or change in polyp burden (number or size). Quantitative synthesis or meta-analysis will be considered. We will also construct a network meta-analysis (NMA) to improve precision of the comparisons among chemo-preventive interventions by combining direct and indirect evidence. The probability of each treatment being the best and/or safest, the number-needed-to-treat [NNT; 95% credible interval (CrIs)], and the number-needed-to-harm (NNH; 95% CrIs) will be calculated to provide measures of treatment efficacy. The GRADE approach will be used to rate the quality of evidence of estimates derived from NMA. Results This protocol has been registered (registration number: CRD42015025849) with the PROSPERO (International Prospective Register of Systematic Reviews). The procedures of this systematic review and NMA will be conducted in accordance with the PRISMA-compliant guideline. The results of this systematic review and
Background Given the increase in overweight and obesity prevalence in adolescents in the last decade, effective prevention strategies for these conditions in adolescents are urgently needed. The PRALIMAP (Promotion de l'ALImentation et de l'Activité Physique) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies -- educational, screening and environmental -- applied singly or in combination in high schools over a 2-year intervention period. Methods PRALIMAP is a stratified 2 × 2 × 2 factorial cluster randomised controlled trial including 24 state high schools in Lorraine, northeastern France, in 2 waves: 8 schools in 2006 (wave 1) and 16 in 2007 (wave 2). Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection. Interventional strategies are organized over 2 academic years. The follow-up consists of 3 visits: at the entry of grade 10 (T0), grade 11 (T1) and grade 12 (T2). At T0, 5,458 (85.7%) adolescents participated. The educational strategy consists of nutritional lessons, working groups and a final party. The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing, if necessary, an adapted care management program of 7 group educational sessions. The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities, especially catering. The main outcomes are body size evolution over time, nutritional behaviour and knowledge, health and quality of life. An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention, allowing for a per protocol analysis after the main intention-to-treat analysis. Discussion PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice. Particular attention is
Background There is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity. Methods and design This article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS
Harris, Tess; Kerry, Sally M.; Victor, Christina R.; Ekelund, Ulf; Woodcock, Alison; Iliffe, Steve; Whincup, Peter H.; Beighton, Carole; Ussher, Michael; Limb, Elizabeth S.; David, Lee; Brewin, Debbie; Adams, Fredrika; Rogers, Annabelle; Cook, Derek G.
Background Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA. Methods and Findings A total of 988 60–75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention’s acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control
Ptolemy, Adam S; Tzioumis, Emma; Thomke, Arjun; Rifai, Sami; Kellogg, Mark
Targeted analyses of clinically relevant metabolites in human biofluids often require extensive sample preparation (e.g., desalting, protein removal and/or preconcentration) prior to quantitation. In this report, a single ultra-centrifugation based sample pretreatment combined with a designed liquid chromatography-tandem mass spectrometry (LC-MS/MS) protocol provides selective quantification of 3,7-dimethylxanthine (theobromine) and 1,3,7-trimethylxanthine (caffeine) in human saliva, plasma and urine samples. The optimized chromatography permitted elution of both analytes within 1.3 min of the applied gradient. Positive-mode electrospray ionization and a triple quadruple MS/MS instrument operated in multiple reaction mode were used for detection. (13)C(3) isotopically labeled caffeine was included as an internal standard to improve accuracy and precision. Implementing a 20-fold dilution of the isolated low MW biofluid fraction prior to injection effectively minimized the deleterious contributions of all three matrices to quantitation. The assay was linear over a 160-fold concentration range from 2.5 to 400 micromol L(-1) for both theobromine (average R(2) 0.9968) and caffeine (average R(2) 0.9997) respectively. Analyte peak area variations for 2.5 micromol L(-1) caffeine and theobromine in saliva, plasma and urine ranged from 5 and 10% (intra-day, N=10) to 9 and 13% (inter-day, N=25) respectively. The intra- and inter-day precision of theobromine and caffeine elution times were 3 and <1% for all biofluids and concentrations tested. Recoveries for caffeine and theobromine ranged from 114 to 118% and 99 to 105% at concentration levels of 10 and 300 micromol L(-1). This validated protocol also permitted the relative saliva, plasma and urine distribution of both theobromine and caffeine to be quantified following a cocoa intervention.
Ptolemy, Adam S; Tzioumis, Emma; Thomke, Arjun; Rifai, Sami; Kellogg, Mark
Targeted analyses of clinically relevant metabolites in human biofluids often require extensive sample preparation (e.g., desalting, protein removal and/or preconcentration) prior to quantitation. In this report, a single ultra-centrifugation based sample pretreatment combined with a designed liquid chromatography-tandem mass spectrometry (LC-MS/MS) protocol provides selective quantification of 3,7-dimethylxanthine (theobromine) and 1,3,7-trimethylxanthine (caffeine) in human saliva, plasma and urine samples. The optimized chromatography permitted elution of both analytes within 1.3 min of the applied gradient. Positive-mode electrospray ionization and a triple quadruple MS/MS instrument operated in multiple reaction mode were used for detection. (13)C(3) isotopically labeled caffeine was included as an internal standard to improve accuracy and precision. Implementing a 20-fold dilution of the isolated low MW biofluid fraction prior to injection effectively minimized the deleterious contributions of all three matrices to quantitation. The assay was linear over a 160-fold concentration range from 2.5 to 400 micromol L(-1) for both theobromine (average R(2) 0.9968) and caffeine (average R(2) 0.9997) respectively. Analyte peak area variations for 2.5 micromol L(-1) caffeine and theobromine in saliva, plasma and urine ranged from 5 and 10% (intra-day, N=10) to 9 and 13% (inter-day, N=25) respectively. The intra- and inter-day precision of theobromine and caffeine elution times were 3 and <1% for all biofluids and concentrations tested. Recoveries for caffeine and theobromine ranged from 114 to 118% and 99 to 105% at concentration levels of 10 and 300 micromol L(-1). This validated protocol also permitted the relative saliva, plasma and urine distribution of both theobromine and caffeine to be quantified following a cocoa intervention. PMID:20045386
Mertens, Jennifer R.; Ward, Catherine L.; Bresick, Graham F.; Broder, Tina; Weisner, Constance M.
Aims: To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. Methods: A randomized controlled trial in a public-sector clinic in Delft, a township in the Western Cape, South Africa recruited 403 patients who were randomized to either single-session, nurse practitioner-delivered Brief Motivational Intervention plus referral list or usual care plus referral list, and followed up at 3 months. Results: Although rates of at-risk alcohol use and drug use did not differ by treatment arm at follow-up, patients assigned to the Brief Motivational Intervention had significantly reduced scores on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) for alcohol—the most prevalent substance. Conclusion: Brief Motivational Intervention may be effective at reducing at-risk alcohol use in the short term among low-income young adult primary care patients; additional research is needed to examine long-term outcomes. PMID:24899076
Dixon, Mari-Newton; Keasling, Michelle
Therapeutic hypothermia (TH) reduces neurologic injury and mortality in out-of-hospital cardiac arrest survivors. Myocardial infarction (MI) is one of the main causes of cardiac arrest and primary percutaneous coronary intervention (PCI) is recommended as initial treatment for patients who present with acute ST-segment elevated MI (STEMI). Cape Fear Valley Medical Center (CFVMC) was the only designated PCI center in the state of North Carolina without a TH protocol. The purpose of this quality improvement initiative was to develop and implement a TH protocol for postcardiac arrest STEMI patients at CFVMC. The existing STEMI process was adapted to include the use of TH for STEMI patients who presented from out-of-hospital cardiac arrest. Steps to development of the protocol included creation of TH STEMI flow map, reallocation of nursing staff, exploration of cooling methods and equipment options, development of a evidence-based physician order set, creation of nursing documentation process and competency assessment, organization of educational sessions, and approval through multiple hospital committees. The development of a postarrest STEMI TH protocol involved multiple disciplines and required approval from several committees. Lack of physician and nursing knowledge of the protocol proved to be the greatest challenge. The TH protocol is a step forward in implementing evidence-based practice and improving the quality of postresuscitation care provided to postcardiac arrest STEMI patients.
Background Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem. Methods/Design This is a single centre study conducted at Queen’s Medical Centre, Nottingham; a large regional trauma centre in England. It is a pragmatic, parallel arm, randomized controlled trial. Sample size will be 150 participants (75 in each group). Randomization will be web-based, using computer generated concealed tables (service provided by Nottingham University Clinical Trials Unit). There is no blinding. Intervention will be a femoral nerve block (0.5 mls/kg 0.25% levo-bupivacaine) followed by ropivacaine (0.2% 5 ml/hr−1) infused via a femoral nerve catheter until 48 hours post-surgery. The control group will receive standard care. Participants will be aged over 70 years, cognitively intact (abbreviated mental score of seven or more), able to provide informed consent, and admitted directly through the Emergency Department from their place of residence. Primary outcomes will be cumulative ambulation score (from day 1 to 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Secondary outcomes will be cumulative dynamic pain score preoperatively, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). Discussion Many studies have shown the effectiveness of regional blockade in neck of femur fractures, but the techniques used have varied. This study aims to identify whether early and continuous femoral nerve block can be effective in relieving pain and enhancing mobilization
Siewerdsen, J. H.; Daly, M. J.; Bachar, G.; Moseley, D. J.; Bootsma, G.; Brock, K. K.; Ansell, S.; Wilson, G. A.; Chhabra, S.; Jaffray, D. A.; Irish, J. C.
High-performance intraoperative imaging is essential to an ever-expanding scope of therapeutic procedures ranging from tumor surgery to interventional radiology. The need for precise visualization of bony and soft-tissue structures with minimal obstruction to the therapy setup presents challenges and opportunities in the development of novel imaging technologies specifically for image-guided procedures. Over the past ~5 years, a mobile C-arm has been modified in collaboration with Siemens Medical Solutions for 3D imaging. Based upon a Siemens PowerMobil, the device includes: a flat-panel detector (Varian PaxScan 4030CB); a motorized orbit; a system for geometric calibration; integration with real-time tracking and navigation (NDI Polaris); and a computer control system for multi-mode fluoroscopy, tomosynthesis, and cone-beam CT. Investigation of 3D imaging performance (noise-equivalent quanta), image quality (human observer studies), and image artifacts (scatter, truncation, and cone-beam artifacts) has driven the development of imaging techniques appropriate to a host of image-guided interventions. Multi-mode functionality presents a valuable spectrum of acquisition techniques: i.) fluoroscopy for real-time 2D guidance; ii.) limited-angle tomosynthesis for fast 3D imaging (e.g., ~10 sec acquisition of coronal slices containing the surgical target); and iii.) fully 3D cone-beam CT (e.g., ~30-60 sec acquisition providing bony and soft-tissue visualization across the field of view). Phantom and cadaver studies clearly indicate the potential for improved surgical performance - up to a factor of 2 increase in challenging surgical target excisions. The C-arm system is currently being deployed in patient protocols ranging from brachytherapy to chest, breast, spine, and head and neck surgery.
Feldman, Inna; Eurenius, Eva; Häggström, Jenny; Sampaio, Filipa; Lindkvist, Marie; Pulkki-Brännström, Anni-Maria; Ivarsson, Anneli
Introduction There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Västerbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the child's first 2 years of life. Methods A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the child's birth, 1 month after the child's birth and 2 years after the child's birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the children's lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis. Ethics and dissemination The Regional Ethical Review Board in Umeå has given clearance for the Salut Programme research (2010-63-31M). No individual's identity will be revealed when presenting results. This study will provide information that can guide
Hossain, Mohammad S; Harvey, Lisa A; Rahman, Md. Akhlasur; Muldoon, Stephen; Islam, Md. Shofiqul; Jan, Stephen; Taylor, Valerie; Cameron, Ian D; Chhabra, Harvinder Singh; Lindley, Richard I; Biering-Sørensen, Fin; Li, Qiang; Dhakshinamurthy, Murali; Herbert, Robert D
Introduction In low-income and middle-income countries, people with spinal cord injury (SCI) are vulnerable to life-threatening complications after they are discharged from hospital. The aim of this trial is to determine the effectiveness and cost-effectiveness of an inexpensive and sustainable model of community-based care designed to prevent and manage complications in people with SCI in Bangladesh. Methods and analysis A pragmatic randomised controlled trial will be undertaken. 410 wheelchair-dependent people with recent SCI will be randomised to Intervention and Control groups shortly after discharge from hospital. Participants in the Intervention group will receive regular telephone-based care and three home visits from a health professional over the 2 years after discharge. Participants in the Control group will receive standard care, which does not involve regular contact with health professionals. The primary outcome is all-cause mortality at 2 years. Recruitment started on 12 July 2015 and the trial is expected to take 5 years to complete. Ethics and dissemination Ethical approval was obtained from the Institutional Ethics Committee at the site in Bangladesh and from the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval, the NHMRC National Statement on Ethical Conduct in Human Research (2007), the Note for Guidance on Good Clinical Practice (CPMP/ICH-135/95) and the Bangladesh Guidance on Clinical Trial Inspection (2011). The results of the trial will be disseminated through publications in peer-reviewed scientific journals and presentations at scientific conferences. Trial registration numbers ACTRN12615000630516, U1111-1171-1876. PMID:26743709
Gupta, Madhu; Angeli, Federica; van Schayck, Onno C. P.; Bosma, Hans
Background A multiple-strategy community intervention, known as National Rural Health Mission (NRHM), launched in India to improve the availability of and access to better-quality healthcare, especially for rural, poor mothers and children. The final goal of the intervention is to reduce maternal and child health inequalities across geographical areas, socioeconomic status groups, and sex of the child. Extensive, in-depth research is necessary to assess the effectiveness of NRHM, on multiple outcome dimensions. This paper presents the design of a new study, able to overcome the shortcomings of previous research. Objective To propose a comprehensive, methodologically sound protocol to assess the extent of implementation and the effectiveness of NRHM measures to improve maternal and child health outcomes and reduce maternal and child health inequalities. Design A mixed-methods approach (quantitative and qualitative) is proposed for this study in Haryana, a state in North India. NRHM's health sector plans included health system strengthening, specific maternal and child healthcare strategies, and communitization. Mission documents and reports on progress, financial monitoring, and common and joint review will be reviewed in-depth to assess the extent of the implementation of plans. Data on maternal and child health indicators will be obtained from demographic health surveys held before, during, and after the implementation of the first phase of the NRHM (2005–2012) and compared over time. Differences in maternal and child health indicators will be used to measure maternal and child health inequalities; these will be compared pre- and post-NRHM. Focus group discussions (FGDs) with service providers and in-depth interviews with program managers, community representatives, and mothers will be conducted until data saturation is achieved, in two districts of Haryana. Using Nvivo software, an inductive qualitative content analysis will be performed to search for the
Lantz, M S; Buchalter, E N; McBee, L
Elderly nursing home residents face the challenge of coping with the loss of independence, reduced physical abilities, feelings of isolation, anxiety, depression, and helplessness. Maintaining one's integrity within the nursing home is a challenge easily lost. Issues of coping with disability, change in body image, the promotion of self-empowerment, and autonomy are critical to preserving the personhood of a nursing home resident. Current emphasis on the management of behavior has focused entirely on the control of disruption rather than the promotion of resident strengths and abilities. We developed a group therapy program designed to enhance self-awareness, self-esteem, and body awareness among the demented elderly. Techniques of meditation, relaxation, sensory awareness and guided imagery were introduced and reinforced. This group is easily reproducible and offers benefits to both residents and interdisciplinary staff.
... sex with someone infected with Zika, examine the importance of screening protocols, and understand likely symptoms, such ... Job Center ENA provides opportunity for education and leadership as well as resources to advance nursing careers. ...
Imamura, Kotaro; Kawakami, Norito; Furukawa, Toshi A; Matsuyama, Yutaka; Shimazu, Akihito; Kasai, Kiyoto
Introduction The aim of this study is to examine the effects of an internet-based cognitive behavioural therapy (iCBT) program on decreasing the risk of major depressive episodes (MDEs) among workers employed in a private corporate group in Japan, using a randomised controlled trial design. Methods and analysis All of the workers in a corporate group (n=20 000) will be recruited through an invitation email. Participants who fulfil the inclusion criteria will be randomly allocated to intervention or control groups (planned N=4050 for each group). They will be allowed to complete the six lessons of the iCBT program within 10 weeks after the baseline survey. Those in the control group will receive the same iCBT after 12 months. The program includes several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem-solving and relaxation. The primary outcome measure is no new onset of MDE (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)/DSM-5 criteria) during the 12-month follow-up. Assessment will use the web version of the WHO Composite International Diagnostic Interview V.3.0 depression section. Ethics and dissemination The Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 3083-(2)), approved the study procedures. Trial registration number The study protocol is registered at the UMIN Clinical Trials Registry (UMIN-CTR; ID=UMIN000014146). PMID:25968004
Daniel, CarolAnn; Newman, Peter A; Loutfy, Mona R
Introduction Haiti has the highest HIV infection rate in the Western hemisphere, with approximately one in 50 people infected. The January 2010 earthquake led to the collapse of Haiti's social, economic and health infrastructure, exacerbating social and structural HIV risk factors. Internally displaced (ID) women are particularly at high risk for HIV infection due to breakdown of community networks, increased poverty and sexual violence. The authors present the rationale and study protocol for pilot-testing FASY (Famn an Aksyon Pou Santé Yo) (Women Taking Action For Their Health), a psychoeducational HIV/STI prevention intervention with ID women in Haiti. Methods and analysis This is a single-centre pragmatic N-of-1 pilot study. The target population is ID women in Leogane, Haiti. The authors aim to recruit 200 participants using purposive peer-driven recruitment methods. ID women will be trained as community health workers to deliver the FASY intervention in Kreyol. Participants will conduct a pretest that involves an individual HIV/STI educational video-based component followed by a 6-week group programme of 2 h women's health meetings. The primary outcome is HIV knowledge; our prespecified index of clinically significant change is an effect size of 0.30. Secondary outcomes include: sexually transmitted infections knowledge, condom use, social support, resilient coping, depression and relationship control. Multivariate analysis of variance will be used to compare pretest and post-test differences across variables to assess if the intervention influenced primary or secondary outcomes. Significant multivariate analysis of variance will be followed up with both univariate tests and discriminant function analyses to understand significant effects. Ethics and dissemination Research Ethics Board approval (2011-0033-E) was attained from the Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. Trial results will be published according to the
Chen, Juliana; Allman-Farinelli, Margaret
Background Despite social marketing campaigns and behavior change interventions, young adults remain among the lowest consumers of vegetables. The digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web, and mobile applications. The effectiveness and generalizability of such programs have not been well documented. Objective The aim of this systematic review is to evaluate the efficacy and external validity of social marketing, electronic, and mobile phone-based (mHealth) interventions aimed at increasing vegetable intake in young adults. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review. The search strategy will be executed across eleven electronic databases using combinations of the following search terms: “online intervention”, “computer-assisted therapy”, “internet”, “website”, “cell phones”, “cyber”, “telemedicine”, “email”, “social marketing”, “social media”, “mass media”, “young adult”, and “fruit and vegetables”. The reference lists of included studies will also be searched for additional citations. Titles and abstracts will be screened against inclusion criteria and full texts of potentially eligible papers will be assessed by two independent reviewers. Data from eligible papers will be extracted. Quality and risk of bias will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and The Cochrane Collaboration Risk of Bias assessment tool respectively. The external validity of the studies will be determined based on components such as reach, adoption, and representativeness of participants; intervention implementation and adaption; and program maintenance and institutionalization. Results will be reported quantitatively and qualitatively. Results Our research is in progress. A draft
Background There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. Methods This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work
Bailey, Julia V; Webster, Rosie; Hunter, Rachael; Freemantle, Nick; Rait, Greta; Michie, Susan; Estcourt, Claudia; Anderson, Jane; Gerressu, Makeda; Stephenson, Judith; Ang, Chee Siang; Hart, Graham; Dhanjal, Sacha; Murray, Elizabeth
Introduction Sexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed results. Interactive digital interventions may provide a suitable alternative, allowing private access to personally tailored behaviour change support. We have developed an interactive digital intervention (the Men's Safer Sex (MenSS) website) which aims to increase condom use in men. We describe the protocol for a pilot trial to assess the feasibility of a full-scale randomised controlled trial of the MenSS website in addition to usual sexual health clinical care. Methods and analysis Participants: Men aged 16 or over who report female sexual partners and recent unprotected sex or suspected acute STI. Participants (N=166) will be enrolled using a tablet computer in clinic waiting rooms. All trial procedures will be online, that is, eligibility checks; study consent; trial registration; automated random allocation; and data submission. At baseline and at 3, 6 and 12 months, an online questionnaire will assess condom use, self-reported STI diagnoses, and mediators of condom use (eg, knowledge, intention). Reminders will be by email and mobile phone. The primary outcome is condom use, measured at 3 months. STI rates will be recorded from sexual health clinic medical records at 12 months. The feasibility of a cost-effectiveness analysis will be assessed, to calculate incremental cost per STI prevented (Chlamydia or Gonorrhoea), from the NHS perspective. Ethics and dissemination Ethical approval: City and East NHS Research Ethics Committee (reference number 13 LO 1801). Findings will be made available through publication in peer-reviewed journals, and to participants and members of the public via Twitter and from the University College London eHealth Unit website. Raw data will be made available on request. Trial registration
Barley, Elizabeth A.; Walters, Paul; Haddad, Mark; Phillips, Rachel; Achilla, Evanthia; McCrone, Paul; Van Marwijk, Harm; Mann, Anthony; Tylee, Andre
Background Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. Methods Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. Result 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. Conclusions Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU
Yearous, Sharon Kay Guthrie
The independent, complex role of a school nurse requires accurate documentation of assessments, interventions, and outcomes. Consistent documentation by all school nurses is crucial to study the impact of nursing interventions on children's health and success in school. While standardized nursing languages are available, the actual use of…
Parsons, Lynn C; Revell, Maria A
Health care organizations must adopt a culture of safety and implement effective fall prevention protocols. The teach-back method is a useful strategy for health providers to determine patient understanding of information taught to maintain a safe environment and prevent falls. Purposeful rounding is a proactive approach to ensure that patient assessments are accurate and research supports that patients use the call light less when nurses participate in hourly rounding. This article provides the reader with evidence-based fall prevention interventions, tips for using the teach-back method, and fall prevention tools to safely care for patients of all ages.
Background The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown. Methods/design We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care (“usual”) transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. Discussion The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT. Trial registration Clinicaltrials.gov number NCT01261910 PMID:24245948
Wójcicki, Thomas R; Roberts, Sarah A; Learmonth, Yvonne C; Hubbard, Elizabeth A; Kinnett-Hopkins, Dominque; Motl, Robert W; McAuley, Edward
Introduction There is a need to identify innovative, low-cost and broad-reaching strategies for promoting exercise and improving physical function in older adults with multiple sclerosis (MS). Methods and analysis This randomised controlled pilot trial will test the efficacy of a 6-month, DVD-delivered exercise intervention to improve functional performance and quality of life in older adults with MS. Participants will be randomised either into a DVD-delivered exercise condition or an attentional control condition. This novel approach to programme delivery provides participants with detailed exercise instructions which are presented in a progressive manner and includes a variety of modifications to better meet varying levels of physical abilities. The targeted exercises focus on three critical elements of functional fitness: flexibility, strength and balance. It is hypothesised that participants who are randomised to the exercise DVD condition will demonstrate improvements in physical function compared with participants assigned to the attentional control condition. Data analysis will include a 2 (condition)×2 (time) mixed factor analysis of variance (ANOVA) that follows intent-to-treat principles, as well as an examination of effect sizes. Participants will take part in qualitative interviews about perspectives on physical activity and programme participation. Ethics and dissemination The study protocol was approved by a university institutional review board and registered with a federal database. Participants will be asked to read and sign a detailed informed consent document and will be required to provide a physician's approval to participate in the study. The exercise DVDs include an overview of safety-related concerns and recommendations relative to exercise participation, as well as detailed instructions highlighting the proper execution of each exercise presented on screen. Following completion of this trial, data will be immediately analysed and results
In the first of two articles on the development of the emergency nurse practitioner, Peter Howie reports on a new scheme in Lincoln where all first-level nurses have been trained as nurse practitioners. The initiative was introduced following a study in the theoretical management of patients by experienced accident and emergency sisters. The author outlines the training course provided and the protocols within which nurse practitioners work. PMID:27236949
In the first of two articles on the development of the emergency nurse practitioner, Peter Howie reports on a new scheme in Lincoln where all first-level nurses have been trained as nurse practitioners. The initiative was introduced following a study in the theoretical management of patients by experienced accident and emergency sisters. The author outlines the training course provided and the protocols within which nurse practitioners work. PMID:1392461
Russell, Ian; Durai, Dharmaraj; Cheung, Wai Yee; Farrin, Amanda; Bloor, Karen; Coulton, Simon; Richardson, Gerry
Objective To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy. Design Pragmatic trial with Zelen’s randomisation before consent to minimise distortion of existing practice. Setting 23 hospitals in the United Kingdom. In six hospitals, nurses undertook both upper and lower gastrointestinal endoscopy, yielding a total of 29 centres. Participants 67 doctors and 30 nurses. Of 4964 potentially eligible patients, we randomised 4128 (83%) and recruited 1888 (38%) from July 2002 to June 2003. Interventions Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy, undertaken with or without sedation, with the standard preparation, techniques, and protocols of participating hospitals. After referral for either procedure, patients were randomised between doctors and nurses. Main outcome measures Gastrointestinal symptom rating questionnaire (primary outcome), gastrointestinal endoscopy satisfaction questionnaire and state-trait anxiety inventory (all analysed by intention to treat); immediate and delayed complications; quality of examination and corresponding report; patients’ preferences for operator; and new diagnoses at one year (all analysed according to who carried out the procedure). Results There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant. Conclusions Diagnostic endoscopy can be undertaken safely and effectively by nurses. Trial registration International standard RCT 82765705 PMID:19208714
Kearns, Rachel; Siegler, Aaron J; Phaswana-Mafuya, Nancy; Bekker, Linda-Gail; Stephenson, Rob; Baral, Stefan D; Brookmeyer, Ron; Yah, Clarence S; Lambert, Andrew J; Brown, Benjamin; Rosenberg, Eli; Blalock Tharp, Mondie; de Voux, Alex; Beyrer, Chris; Sullivan, Patrick S
Background Human immunodeficiency virus (HIV) prevention intervention programs and related research for men who have sex with men (MSM) in the southern African region remain limited, despite the emergence of a severe epidemic among this group. With a lack of understanding of their social and sexual lives and HIV risks, and with MSM being a hidden and stigmatized group in the region, optimized HIV prevention packages for southern African MSM are an urgent public health and research priority. Objective The objective of the Sibanye Health Project is to develop and evaluate a combination package of biomedical, behavioral, and community-level HIV prevention interventions and services for MSM in South Africa. Methods The project consists of three phases: (1) a comprehensive literature review and summary of current HIV prevention interventions (Phase I), (2) agent-based mathematical modeling of HIV transmission in southern African MSM (Phase II), and (3) formative and stigma-related qualitative research, community engagement, training on providing health care to MSM, and the pilot study (Phase III). The pilot study is a prospective one-year study of 200 men in Cape Town and Port Elizabeth, South Africa. The study will assess a package of HIV prevention services, including condom and condom-compatible lubricant choices, risk-reduction counseling, couples HIV testing and counseling, pre-exposure prophylaxis (PrEP) for eligible men, and non-occupational post-exposure prophylaxis for men with a high risk exposure. The pilot study will begin in October 2014. Results Preliminary results from all components but the pilot study are available. We developed a literature review database with meta-data extracted from 3800 documents from 67 countries. Modeling results indicate that regular HIV testing and promotion of condom use can significantly impact new HIV infections among South African MSM, even in the context of high coverage of early treatment of HIV-positive men and high
Deckers, Bernhard; von Schoen-Angerer, Tido; Voggenreiter, Bernd; Vagedes, Jan
Prolonged postoperative ileus is a common but clinically challenging problem that leads to patient discomfort and prolonged hospitalization; the condition is managed through a multimodular program of supportive measures. In anthroposophic nursing, the management of prolonged postoperative ileus involves additional tools, including external abdominal compresses and massages with plant or silver-containing oils and ointments. We describe 3 typical techniques: Oxalis tincture compresses, Thuja/Argentum ointment compresses, and massage with "Wala Melissenöl" (containing Melissa officinalis, Carvum cari, Foeniculum amari, and Origanum majorana). A 61-year-old man with chronic pain from adhesions after multiple abdominal surgical procedures developed a prolonged postoperative ileus after an elective ileostomy reversal. Following slow recovery during the first postoperative days, he began vomiting. A nasogastric tube was inserted, and daily Oxalis tincture compresses and massage with "Wala Melissenöl" and Thuja/Argentum ointment compresses were applied on the abdomen. The patient's symptoms gradually improved over the next 10 days. No prokinetic medications were needed to manage this episode. External abdominal nursing applications with plant substances and silver can be an additional tool in the management of prolonged postoperative ileus. PMID:27309410
The objective of this study was to describe and understand the experiences of teenagers with cleft lip and/or palate. The human ecology approach of Bronfenbrenner (1979) was chosen as a basis for this study. From this perspective, the living environment of teenagers with cleft lip and/or palate was considered, and as such, qualitative research from an ethnographic standpoint was conducted. The data were collected by semistructured interviews and recorded on magnetic tape. Ten teenagers, between 15 and 17 years of age, were chosen and consulted while undergoing therapeutic treatment and surgery in a cleft lip and/or palate clinic. The results of this study indicate that teenagers born with this congenital malformation experience various physical, functional, or interactional problems throughout their development. To improve this situation, nursing care has been developed to enable the nurse to act within the multidisciplinary team treating cleft lip and/or palate cases, thereby allowing the teenager to develop in an environment that offers a better quality of life.
Chen, Cheryl Chia-Hui; Saczynski, Jane; Inouye, Sharon K
The purpose of this article is to provide the rationale and methods for adapting the Hospital Elder Life Program (HELP). The HELP is a complex intervention that has been shown to reduce rates of delirium and functional decline. However, modification of the program may be required to meet local circumstances and specialized populations. We selected three key elements based on our prior work and the concept of shared risk factors and modified the HELP to include only three shared risk factors (functional, nutritional, and cognitive status) that were targeted by three nursing protocols: early mobilization, oral and nutritional assistance, and orienting communication. These protocols were adapted, refined, and pilot-tested for feasibility and efficacy. We hope by reporting the rationale and protocols for the modified HELP, we will advance the field for others adapting evidence-based, complex nursing interventions.
Chen, Cheryl Chia-Hui; Saczynski, Jane; Inouye, Sharon K
The purpose of this article is to provide the rationale and methods for adapting the Hospital Elder Life Program (HELP). The HELP is a complex intervention that has been shown to reduce rates of delirium and functional decline. However, modification of the program may be required to meet local circumstances and specialized populations. We selected three key elements based on our prior work and the concept of shared risk factors and modified the HELP to include only three shared risk factors (functional, nutritional, and cognitive status) that were targeted by three nursing protocols: early mobilization, oral and nutritional assistance, and orienting communication. These protocols were adapted, refined, and pilot-tested for feasibility and efficacy. We hope by reporting the rationale and protocols for the modified HELP, we will advance the field for others adapting evidence-based, complex nursing interventions. PMID:24443887
Fritsch, Thomas; Kwak, Jung; Grant, Stacey; Lang, Josh; Montgomery, Rhonda R.; Basting, Anne D.
Purpose: Creative expression (CE) programs are emerging interventions to improve the quality of care and life of persons with dementia (PWDs) in long-term care settings. However, limited empirical evidence exists to support the effectiveness of these programs. Here, we report the findings from an assessment of the impact of TimeSlips (TS), a group…
Verwey, R; van der Weegen, S; Spreeuwenberg, M; Tange, H; van der Weijden, T; de Witte, L
An iterative user-centered design method was used to develop and test mobile technology (the It's LiFe! tool/monitor) embedded in primary care, followed by a three months feasibility study with 20 patients and three nurses. The tool consists of an accelerometer that transfers data to an app on a Smartphone, which is subsequently connected to a server. Physical activity levels are measured in minutes per day compared to pre-set activity goals, which are set by patients in dialogue with nurses. Nurses can monitor patients' physical activity via a secured website. The counseling protocol is based on the Five A's model and consists of a limited number of behavior change consultations intertwined with interaction with and responses from the tool. The technology supports nurses when performing physical activity counseling. Provided that no connectivity problems occur, the It's LiFe! intervention is feasible, and its longitudinal effects will be tested in a cluster RCT.
Background Home visiting nurses (HVNs) have long been part of home and community-based care interventions designed to meet the needs of functionally declining older adults. However, only one of the studies including HVNs that have demonstrated successful impacts on Activities of Daily Living (ADL) has reported how those interventions affected individual ADLs such as bathing, instead reporting the effect on means of various ADL indices and scales. Reporting impacts on means is insufficient since the same mean can consist of many different combinations of individual ADL impairments. The purpose of our study was to identify which individual ADLs were affected by a specific HVN intervention. Methods This is a secondary analysis comparing two arms of a randomized controlled study that enrolled Medicare patients (mean age = 76.8 years; 70% female) with considerable ADL impairment. At baseline difficulty with individual ADLs ranged from a low of 16.0% with eating to a high of 78.0% with walking. Through monthly home visits, the HVN focused on empowering patients and using behavior change approaches to facilitate chronic disease self-management. Three categories of analyses were used to compare difficulty with and dependence in 6 individual ADLs between the HVN (n = 237) and care as usual (n = 262) groups (total N = 499) at 22 months after study entry: (1) unadjusted analyses that strictly depend on random assignment, (2) multinomial logistic regression analyses adjusting for baseline risk factors, and (3) multinomial regression analyses that include variables reporting post-randomization healthcare use as well as the baseline risk factors. Results Compared to care as usual, patients receiving the HVN intervention had less difficulty performing bathing at 22 months. However, there were no effects for difficulty performing the other 5 ADLs. While no effects were found for lower levels of dependence for any ADLs, impacts were detected for the most
Tjale, A A; Bruce, J
Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has
Hay, Jennifer L; Oliveria, Susan A; Dusza, Stephen W; Phelan, Deborah L; Ostroff, Jamie S; Halpern, Allan C
This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months. PMID:16775183
Savage, S; Simms, L M; Williams, R A; Erbin-Roesemann, M
An interest in what makes work exciting among Navy Nurse Corps officers led to the use of Simms' work excitement data collection protocol in Navy Medical Centers. Significant levels of work excitement were found among Navy nurses when compared to civilian nurses in non-military settings. Overall, results indicated that Navy nurses are excited about the variety, the leadership/management experiences, and the opportunities for teaching and learning--elements that are the very essence of Navy nursing practice. PMID:8345880
Effective components of exercise and physical activity-related behaviour-change interventions for chronic non-communicable diseases in Africa: protocol for a systematic mixed studies review with meta-analysis
Igwesi-Chidobe, Chinonso N; Godfrey, Emma L; Kengne, Andre P
Introduction Chronic non-communicable diseases (NCDs) account for a high burden of mortality and morbidity in Africa. Evidence-based clinical guidelines recommend exercise training and promotion of physical activity behaviour changes to control NCDs. Developing such interventions in Africa requires an understanding of the essential components that make them effective in this context. This is a protocol for a systematic mixed studies review that aims to determine the effective components of exercise and physical activity-related behaviour-change interventions for chronic diseases in Africa, by combining quantitative and qualitative research evidence from studies published until July 2015. Methods and analysis We will conduct a detailed search to identify all published and unpublished studies that assessed the effects of exercise and physical activity-related interventions or the experiences/perspectives of patients to these interventions for NCDs from bibliographic databases and the grey literature. Bibliographic databases include MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO, CINAHL and Web of Science. We will include the following African regional databases: African Index Medicus (AIM) and AFROLIB, which is the WHO's regional office database for Africa. The databases will be searched from inception until 18 July 2015. Appraisal of study quality will be performed after results synthesis. Data synthesis will be performed independently for quantitative and qualitative data using a mixed methods sequential explanatory synthesis for systematic mixed studies reviews. Meta-analysis will be conducted for the quantitative studies, and thematic synthesis for qualitative studies and qualitative results from the non-controlled observational studies. The primary outcome will include exercise adherence and physical activity behaviour changes. This review protocol is reported according to Preferred Reporting Items for Systematic reviews and
Burnout specific to human service workers has been reported in the U.S. in the 1970s. Since then, such burnout has become widely known and the mental health of nurses has attracted attention. Stressors in the work environment and complexity have increased with advancement in increasingly complicated medical care. One of the major roles of a psychiatric liaison nurse is to provide support to improve the mental health of nurses. In our hospital, a psychiatric liaison nurse has a staff position under the direct supervision of the director of the nursing department but operates outside the chain of command. A psychiatric liaison nurse is not involved in the performance review of nurses. Thus, the nursing staff and the nursing manager can discuss their problems with the psychiatric liaison nurse without risks. Psychiatric liaison nurses provide support as counselors through individual and group interviews so that nurses can become re-energized about their work. In addition, psychiatric liaison nurses provide consultations and education. They perform coordination function to organize an environment to promote consultations regarding nurse support to the staff nurses and the nursing manager and to promote support by supervisors. For support after reinstatement of a nurse following a medical leave, it is particularly important to work with not only the individual nurse but also the entire nursing team. In our hospital, newly graduated nurses are given the GHQ-28 after one month of employment to assess the support they might need. In our study, nurses with high risks were divided into a group with a score of at least 6 points but less than 10 points and a group with a score of at least 10 points. The group with at least 10 points had significantly higher rates of leave of absence and resignation. Thus, early intervention was thought to be necessary in newly graduated nurses with a score of at least 10 points in the GHQ.
Alavi, C; Cattoni, J
The construction of the nursing subject is discussed. The paper takes a historical perspective, arguing that the range of speaking positions available to the nurse is limited by gender, class and education. It evaluates the position of nursing in the university, showing how this also has propensity to limit the development of the nursing profession.
Michelson, Daniel; Sclare, Irene; Stahl, Daniel; Morant, Nicola; Bonin, Eva-Maria; Brown, June S L
Adolescence is a vulnerable period for the development of mental health problems. The DISCOVER intervention aims to provide accessible, acceptable and cost-effective psychological support for stressed adolescents in inner-city secondary schools. The intervention uses age-appropriate cognitive-behavioural therapy (CBT) methods and materials, delivered in an interactive 1-day workshop with additional telephone support. An open-access entry route allows students to self-refer. This protocol describes a feasibility cluster randomised controlled trial (RCT) comparing DISCOVER with a waitlist control condition. The study will run across 10 clusters (secondary schools) in the inner London Boroughs of Southwark and Lambeth. Participants are students aged over 16years who are seeking help with anxiety and/or depressive symptoms. Key feasibility parameters relate to the proportion of students willing to participate in the research following publicity events; the proportion of students who complete the intervention; and response rates for outcome measures. Outcome variance estimates and intra-cluster correlations will be obtained for future power calculations. Qualitative methods will be used to explore the acceptability of the intervention and research procedures for students and school staff. The feasibility of an economic evaluation will also be examined. The results will (i) determine the appropriateness of proceeding to a definitive full-scale trial; and (ii) inform the development of an optimised version of the DISCOVER intervention that can be tested within feasible parameters. PMID:26883283
Background Research investigating the effectiveness of universal interventions to reduce the risk of mental health problems remains limited. Schools are a promising setting within which adolescents can receive interventions aimed at promoting their mental health. The aim of this study is to assess the effectiveness of a resilience-based prevention-focused intervention in reducing the risk of mental health problems among adolescents attending secondary school in socio-economically disadvantaged areas. Methods/design A cluster randomised control trial will be conducted, with schools as the unit of randomisation. Initially, 32 secondary schools will be randomly allocated to a control or intervention group (12 control and 20 intervention). An intervention focused on improving student internal and external resilience factors will be implemented in intervention schools. A survey of students in Grade 7 in both intervention and control schools will be conducted (baseline) and repeated three years later when the students are in Grade 10. The Strengths and Difficulties Questionnaire will be used to measure the risk of mental health problems. At follow-up, the risk of mental health problems will be compared between Grade 10 students in intervention and control schools to determine intervention effectiveness. Discussion The study presents an opportunity to determine the effectiveness of a comprehensive resilience-based intervention in reducing the risk of mental health problems in adolescents attending secondary schools. The outcomes of the trial are of importance to youth, schools, mental health clinicians and policymakers. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12611000606987, registered 14 June 2011. PMID:25037455
van Nassau, Femke; Singh, Amika S.; van Mechelen, Willem; Brug, Johannes; Chin A. Paw, Mai J. M.
Background: The school-based Dutch Obesity Intervention in Teenagers (DOiT) program is an evidence-based obesity prevention program. In preparation for dissemination throughout the Netherlands, this study aimed to adapt the initial program and to develop an implementation strategy and materials. Methods: We revisited the Intervention Mapping (IM)…
Denehy, J A
This study of nursing interventions that promote attachment is but one of the building blocks in creating a theoretically strong foundation for nursing practice. With the cooperative and coordinated efforts of nursing theorists, researchers, academicians, and seasoned practitioners, nursing will be able more clearly to define its domain of practice by identifying nursing interventions and the critical and supportive activities that comprise these interventions. With such systematically organized and tested knowledge, nursing practice will become firmly rooted in a knowledge base that will not only lead to improved patient care but enhance professional credibility and satisfaction. PMID:1584698
Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records—REDUCE Trial study original protocol
Juszczyk, Dorota; Charlton, Judith; McDermott, Lisa; Soames, Jamie; Sultana, Kirin; Ashworth, Mark; Fox, Robin; Hay, Alastair D; Little, Paul; Moore, Michael V; Yardley, Lucy; Prevost, A Toby; Gulliford, Martin C
Introduction Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices. Methods and analysis 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms. Ethics and dissemination Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial
Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD). TECEPOC: study protocol for a partially randomized controlled trial (preference trial)
Background Drugs for inhalation are the cornerstone of therapy in obstructive lung disease. We have observed that up to 75 % of patients do not perform a correct inhalation technique. The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction. The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods This study uses both a multicenter patients´ preference trial and a comprehensive cohort design with 495 COPD-diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers. The participants will be divided into two groups and five arms. The two groups are: 1) the patients´ preference group with two arms and 2) the randomized group with three arms. In the preference group, the two arms correspond to the two educational interventions (Intervention A and Intervention B) designed for this study. In the randomized group the three arms comprise: intervention A, intervention B and a control arm. Intervention A is written information (a leaflet describing the correct inhalation techniques). Intervention B is written information about inhalation techniques plus training by an instructor. Every patient in each group will be visited six times during the year of the study at health care center. Discussion Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 %. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, considering that it will be adequate and feasible within the context of clinical practice. Trial registration Current Controlled Trials ISRTCTN15106246 PMID:22613015
Background Schools may have important effects on students' and staff's health. Rather than treating schools merely as sites for health education, 'school-environment' interventions treat schools as settings which influence health. Evidence concerning the effects of such interventions has not been recently synthesised. Methods/design Systematic review aiming to map and synthesise evidence on what theories and conceptual frameworks are most commonly used to inform school-environment interventions or explain school-level influences on health; what effects school-environment interventions have on health/health inequalities; how feasible and acceptable are school-environment interventions; what effects other school-level factors have on health; and through what processes school-level influences affect health. We will examine interventions aiming to promote health by modifying schools' physical, social or cultural environment via actions focused on school policies and practices relating to education, pastoral care and other aspects of schools beyond merely providing health education. Participants are staff and students age 4-18 years. We will review published research unrestricted by language, year or source. Searching will involve electronic databases including Embase, ERIC, PubMed, PsycInfo and Social Science Citation Index using natural-language phrases plus reference/citation checking. Stage 1 will map studies descriptively by focus and methods. Stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by two reviewers in parallel. Evidence will be synthesised narratively and statistically where appropriate (undertaking subgroup analyses and meta-regression and where no significant heterogeneity of effect sizes is found, pooling these to calculate a final effect size). Discussion We anticipate: finding a large number of studies missed by previous reviews; that non-intervention studies of school effects examine a greater
Background Intensive interventions on smoking cessation increase abstinence rates. However, few electronic mail (E-mail) based intensive interventions have been tested in smokers and none in primary care (PC) setting. The aim of the present study is to evaluate the effectiveness of an intensive E-mail based intervention in smokers attending PC services. Methods/design Randomized Controlled Multicentric Trial. Study population: 1060 smokers aged between 18–70 years from Catalonia, Salamanca and Aragón (Spain) who have and check regularly an E-mail account. Patients will be randomly assigned to control or intervention group. Intervention: Six phase intensive intervention with two face to face interviews and four automatically created and personal E-mail patients tracking, if needed other E-mail contacts will be made. Control group will receive a brief advice on smoking cessation. Outcome measures: Will be measured at 6 and 12 months after intervention: self reported continuous abstinence (confirmed by cooximetry), point prevalence abstinence, tobacco consumption, evolution of stage according to Prochaska and DiClemente's Stages of Change Model, length of visit, costs for the patient to access Primary Care Center. Statistical analysis: Descriptive and logistic and Poisson regression analysis under the intention to treat basis using SPSS v.17. Discussion The proposed intervention is an E-mail based intensive intervention in smokers attending primary care. Positive results could be useful to demonstrate a higher percentage of short and long-term abstinence among smokers attended in PC in Spain who regularly use E-mail. Furthermore, this intervention could be helpful in all health services to help smokers to quit. Trial Registration Clinical Trials.gov Identifier: NCT01494246. PMID:23597262
The nurse consultation is an integral part of the treatment of children and adolescents experiencing psychological distress following traumatic events. Specific support is therefore offered to young patients, in particular through the intervention of a clinical nurse specialist.
Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan
Dysphagia (ENCAD) in long-term care settings. 2. Review the outcome of implementing the ENCAD for dysphagia management in a nursing home. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Standardized nursing care protocols for dysphagia management have not been established in nursing home settings in Korea. The purpose of the current study was to examine the effect of the Evidence-Based Nursing Care Algorithm of Dysphagia (ENCAD) on risk of dysphagia, oral health, and dysphagia-specific quality of life among nursing home residents. The ENCAD was administered to 40 residents in one nursing home in urban South Korea for 6 months. A control-intervention, time-series design was used, under which participants served as their own controls. Oral health, risk of aspiration, and dysphagia-specific quality of life were measured at baseline, post-control, and post-intervention. Findings showed that risk of aspiration (p < 0.01) and dysphagia-related quality of life (p < 0.001) improved significantly after the ENCAD was applied, whereas oral health status did not change over time (p = 0.06). Results suggest that implementing the ENCAD contributed to a reduction in the risk of aspiration and an improvement in the quality of life in nursing home residents.
Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan
Dysphagia (ENCAD) in long-term care settings. 2. Review the outcome of implementing the ENCAD for dysphagia management in a nursing home. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Standardized nursing care protocols for dysphagia management have not been established in nursing home settings in Korea. The purpose of the current study was to examine the effect of the Evidence-Based Nursing Care Algorithm of Dysphagia (ENCAD) on risk of dysphagia, oral health, and dysphagia-specific quality of life among nursing home residents. The ENCAD was administered to 40 residents in one nursing home in urban South Korea for 6 months. A control-intervention, time-series design was used, under which participants served as their own controls. Oral health, risk of aspiration, and dysphagia-specific quality of life were measured at baseline, post-control, and post-intervention. Findings showed that risk of aspiration (p < 0.01) and dysphagia-related quality of life (p < 0.001) improved significantly after the ENCAD was applied, whereas oral health status did not change over time (p = 0.06). Results suggest that implementing the ENCAD contributed to a reduction in the risk of aspiration and an improvement in the quality of life in nursing home residents. PMID:26505245
Amoran, Olorunfemi Emmanuel
Introduction: Malaria is the most prevalent parasitic endemic disease in Africa, which is preventable, treatable and curable. This study aims to assess the effect of health education intervention on the knowledge, attitude, and prevention practices amongst mothers of under-five children in a rural area of Ogun State, Nigeria. Materials and Methods: The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State. A multistage random sampling technique was used in choosing the required samples and a semi-structured questionnaire was used to collect relevant information. A total of 400 respondents were recruited into the study with 200 each in both the experimental and control groups and were followed up for a period of 3 months. Results: There was no statistically significant differences observed between the experimental and control groups. Knowledge of indoor spraying increased from 14.7% to 58.2% (P < 0.001) and window and door nets increased from 48.3% to 74.8% (P < 0.001). The proportion of those with ITN use increased from 50.8% to 87.4% (P < 0.001) while those with practice of maintaining clean environment also increased from 40.4% to 54.5% (P < 0.001). There were no significant changes in all the practice of malaria prevention methods in the control group. Conclusion: This suggests that malaria control can be significantly improved in rural areas, if the caregivers are adequately empowered through appropriate health education intervention though change in attitude and belief may require a longer and persistent effort. PMID:23798798
Background Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing. The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multi-component intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children’s obesity. Methods/Design The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the
Lohan, Maria; Aventin, Aine; Maguire, Lisa; Clarke, Mike; Linden, Mark; McDaid, Lisa
The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs. PMID:25284956
Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiv